Healthcare Provider Details

I. General information

NPI: 1720108632
Provider Name (Legal Business Name): MELISSA ANN BUDZYNSKI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 BALL AVE NE
GRAND RAPIDS MI
49505-5904
US

IV. Provider business mailing address

1101 BALL AVE NE
GRAND RAPIDS MI
49505-5904
US

V. Phone/Fax

Practice location:
  • Phone: 616-456-6571
  • Fax: 616-456-5800
Mailing address:
  • Phone: 616-456-6571
  • Fax: 616-456-5800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801068295
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: