Healthcare Provider Details

I. General information

NPI: 1992365266
Provider Name (Legal Business Name): CATHERINE JEAN LANGEREIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4065 E HILLS CT SE
GRAND RAPIDS MI
49546-6249
US

IV. Provider business mailing address

4065 E HILLS CT SE
GRAND RAPIDS MI
49546-6299
US

V. Phone/Fax

Practice location:
  • Phone: 616-942-2081
  • Fax: 616-942-5932
Mailing address:
  • Phone: 616-942-2081
  • Fax: 616-942-5932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: