Healthcare Provider Details

I. General information

NPI: 1275659765
Provider Name (Legal Business Name): TRACY L KARSTEN BSW, LBSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 LEONARD ST NE
GRAND RAPIDS MI
49505-5515
US

IV. Provider business mailing address

1450 LEONARD ST NE
GRAND RAPIDS MI
49505-5515
US

V. Phone/Fax

Practice location:
  • Phone: 616-774-8789
  • Fax: 616-776-1305
Mailing address:
  • Phone: 616-774-8789
  • Fax: 616-776-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802076948
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: