Healthcare Provider Details

I. General information

NPI: 1962894543
Provider Name (Legal Business Name): ELLEN HOVEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 EASTERN AVE NE
GRAND RAPIDS MI
49503-1201
US

IV. Provider business mailing address

901 EASTERN AVE NE
GRAND RAPIDS MI
49503-1201
US

V. Phone/Fax

Practice location:
  • Phone: 616-224-7429
  • Fax: 616-574-7966
Mailing address:
  • Phone: 616-224-7429
  • Fax: 616-574-7966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: