Healthcare Provider Details

I. General information

NPI: 1629577481
Provider Name (Legal Business Name): HEATHER LEIGH FRICKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2018
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2172 DEAN LAKE AVE NE
GRAND RAPIDS MI
49505-4444
US

IV. Provider business mailing address

17684 ROBBINS RD
GRAND HAVEN MI
49417-9318
US

V. Phone/Fax

Practice location:
  • Phone: 616-451-2021
  • Fax:
Mailing address:
  • Phone: 616-251-9603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851120959
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: