Healthcare Provider Details

I. General information

NPI: 1891888087
Provider Name (Legal Business Name): SUSAN M WOLF LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN MARIE NORWAISH MSW

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SHELDON BLVD SE
GRAND RAPIDS MI
49503-4513
US

IV. Provider business mailing address

201 SHELDON BLVD SE
GRAND RAPIDS MI
49503-4513
US

V. Phone/Fax

Practice location:
  • Phone: 616-459-0255
  • Fax: 616-252-6057
Mailing address:
  • Phone: 616-459-0255
  • Fax: 616-242-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801061332
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: