Healthcare Provider Details

I. General information

NPI: 1871451476
Provider Name (Legal Business Name): KEITH J FOISY LLMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2026
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 JEFFERSON AVE SE
GRAND RAPIDS MI
49503-4304
US

IV. Provider business mailing address

30 JEFFERSON AVE SE
GRAND RAPIDS MI
49503-4304
US

V. Phone/Fax

Practice location:
  • Phone: 616-389-0708
  • Fax:
Mailing address:
  • Phone: 616-303-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851121211
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: