Healthcare Provider Details

I. General information

NPI: 1992278113
Provider Name (Legal Business Name): JULIE MARIE BALL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIE MARIE KREITSCH LLMSW

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 RAYBROOK ST SE
GRAND RAPIDS MI
49546-7759
US

IV. Provider business mailing address

2100 RAYBROOK ST SE
GRAND RAPIDS MI
49546-7759
US

V. Phone/Fax

Practice location:
  • Phone: 616-235-5100
  • Fax: 616-235-5050
Mailing address:
  • Phone: 616-235-5100
  • Fax: 616-235-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801092606
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: