Healthcare Provider Details

I. General information

NPI: 1285231993
Provider Name (Legal Business Name): HOLLY PRZYBYLSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY BURSLEY

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1939 S DIVISION AVE.
GRAND RAPIDS MI
49507
US

IV. Provider business mailing address

1939 S DIVISION AVE.
GRAND RAPIDS MI
49507
US

V. Phone/Fax

Practice location:
  • Phone: 616-247-3815
  • Fax:
Mailing address:
  • Phone: 616-247-3815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851109967
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: