Healthcare Provider Details

I. General information

NPI: 1871181115
Provider Name (Legal Business Name): KRISTEN BIANCHI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 IONIA AVE NW APT 709
GRAND RAPIDS MI
49503-3009
US

IV. Provider business mailing address

55 IONIA AVE NW APT 709
GRAND RAPIDS MI
49503-3009
US

V. Phone/Fax

Practice location:
  • Phone: 312-882-2064
  • Fax:
Mailing address:
  • Phone: 312-882-2064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801119998
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: