Healthcare Provider Details

I. General information

NPI: 1619308418
Provider Name (Legal Business Name): CATHY ANN BAILEY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2013
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 LEONARD ST NE
GRAND RAPIDS MI
49505-5515
US

IV. Provider business mailing address

4595 QUEBEC AVE SW
WYOMING MI
49519-4506
US

V. Phone/Fax

Practice location:
  • Phone: 616-375-8221
  • Fax:
Mailing address:
  • Phone: 616-375-8221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801085676
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: