Healthcare Provider Details

I. General information

NPI: 1720990484
Provider Name (Legal Business Name): MRS. MADELYN HEERES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 BALDWIN ST
HUDSONVILLE MI
49426-7376
US

IV. Provider business mailing address

4103 PORT SHELDON ST
HUDSONVILLE MI
49426-8900
US

V. Phone/Fax

Practice location:
  • Phone: 616-797-9797
  • Fax: 616-797-9929
Mailing address:
  • Phone: 616-669-1740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6851119783
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: