Healthcare Provider Details

I. General information

NPI: 1376294892
Provider Name (Legal Business Name): MATTHEW WERKMAN LLMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2022
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 3 MILE RD NW STE G
GRAND RAPIDS MI
49544-8209
US

IV. Provider business mailing address

8666 WALLINWOOD FARMS AVE
JENISON MI
49428-9419
US

V. Phone/Fax

Practice location:
  • Phone: 800-693-1916
  • Fax:
Mailing address:
  • Phone: 616-481-5833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851114051
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: