Healthcare Provider Details

I. General information

NPI: 1700134038
Provider Name (Legal Business Name): ERIN WILLIAMS FISK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ERIN RAE BURCHYETT

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3923 KEARNEY DR NE
GRAND RAPIDS MI
49525-1820
US

IV. Provider business mailing address

3923 KEARNEY DR NE
GRAND RAPIDS MI
49525-1820
US

V. Phone/Fax

Practice location:
  • Phone: 616-888-1113
  • Fax:
Mailing address:
  • Phone: 616-888-1113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801090638
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801090638
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: