Healthcare Provider Details

I. General information

NPI: 1932862794
Provider Name (Legal Business Name): ELIZABETH ANNE NOVAK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH KRENEK LMSW

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 THORNAPPLE RIVER DR SE
GRAND RAPIDS MI
49546-9706
US

IV. Provider business mailing address

5391 MERIDIAN RD
HASLETT MI
48840-9724
US

V. Phone/Fax

Practice location:
  • Phone: 616-226-6138
  • Fax: 616-259-4214
Mailing address:
  • Phone: 517-881-5208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801085183
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: