Healthcare Provider Details

I. General information

NPI: 1730795816
Provider Name (Legal Business Name): ELIZABETH ANNE MAHER LMSW, CLINICAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH ANNE VOSKUIL MSW

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 PONTIAC RD SE
GRAND RAPIDS MI
49506-3367
US

IV. Provider business mailing address

1519 PONTIAC RD SE
GRAND RAPIDS MI
49506-3367
US

V. Phone/Fax

Practice location:
  • Phone: 616-818-8481
  • Fax: 616-361-3492
Mailing address:
  • Phone: 616-818-8481
  • Fax: 616-361-3492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801086681
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: