Healthcare Provider Details

I. General information

NPI: 1609623701
Provider Name (Legal Business Name): ASHLEY ELIZABETH KOLENBRANDER MSW, BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1256 WALKER AVE NW
GRAND RAPIDS MI
49504-4067
US

IV. Provider business mailing address

9429 SUNSET RIDGE DR NE
ROCKFORD MI
49341-7114
US

V. Phone/Fax

Practice location:
  • Phone: 616-451-2039
  • Fax:
Mailing address:
  • Phone: 989-387-4704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851117802
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: