Healthcare Provider Details

I. General information

NPI: 1952922023
Provider Name (Legal Business Name): ISABEL BERKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12265 JAMES ST BLDG A
HOLLAND MI
49424-8613
US

IV. Provider business mailing address

553 WEALTHY ST SE APT 2
GRAND RAPIDS MI
49503-5450
US

V. Phone/Fax

Practice location:
  • Phone: 616-393-5600
  • Fax:
Mailing address:
  • Phone: 847-736-2884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801109574
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: