Healthcare Provider Details

I. General information

NPI: 1497552723
Provider Name (Legal Business Name): ERIN RAUCH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

985 PARCHMENT DR SE
GRAND RAPIDS MI
49546-3659
US

IV. Provider business mailing address

339 SPRUCE ST SE
GRAND RAPIDS MI
49507-3456
US

V. Phone/Fax

Practice location:
  • Phone: 616-425-2412
  • Fax:
Mailing address:
  • Phone: 810-623-9283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851119592APP25
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: