Healthcare Provider Details

I. General information

NPI: 1477073542
Provider Name (Legal Business Name): EMILY WARNING LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 KENMOOR AVE SE STE 100
GRAND RAPIDS MI
49546-2379
US

IV. Provider business mailing address

1111 N HAMPTON DR NE
GRAND RAPIDS MI
49505-5931
US

V. Phone/Fax

Practice location:
  • Phone: 616-425-2176
  • Fax: 616-552-1619
Mailing address:
  • Phone: 616-915-1578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801101203
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: