Healthcare Provider Details

I. General information

NPI: 1760530166
Provider Name (Legal Business Name): MY UYEN TRAN LMSW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 KALAMAZOO AVE SE
GRAND RAPIDS MI
49507-4003
US

IV. Provider business mailing address

PO BOX 585
JENISON MI
49429-0585
US

V. Phone/Fax

Practice location:
  • Phone: 616-617-0296
  • Fax:
Mailing address:
  • Phone: 616-617-0296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801067224
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: