Healthcare Provider Details

I. General information

NPI: 1649097601
Provider Name (Legal Business Name): PAIGE J CAPEL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 LAKE MICHIGAN DR NW STE 103
GRAND RAPIDS MI
49534-4583
US

IV. Provider business mailing address

527 FAIRFIELD AVE NW
GRAND RAPIDS MI
49504-4622
US

V. Phone/Fax

Practice location:
  • Phone: 616-805-3660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801119087
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: