Healthcare Provider Details

I. General information

NPI: 1831711951
Provider Name (Legal Business Name): ARYN MANNI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 FULTON ST E
GRAND RAPIDS MI
49503-3278
US

IV. Provider business mailing address

1004 KUSTERER DR NW
WALKER MI
49534-3608
US

V. Phone/Fax

Practice location:
  • Phone: 269-271-5970
  • Fax:
Mailing address:
  • Phone: 734-674-2130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801106540
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: