Healthcare Provider Details

I. General information

NPI: 1740753151
Provider Name (Legal Business Name): KATHERINE VANRYN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HALL ST, SW SUITE 263
GRAND RAPIDS MI
49503
US

IV. Provider business mailing address

401 HALL ST, SW SUITE 263
GRAND RAPIDS MI
49503
US

V. Phone/Fax

Practice location:
  • Phone: 616-719-0919
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801087769
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: