Healthcare Provider Details

I. General information

NPI: 1356616510
Provider Name (Legal Business Name): OLIVIA HEPWORTH LBSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLIVIA MILLER LBSW

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 APPLE TREE DR
IONIA MI
48846-7506
US

IV. Provider business mailing address

375 APPLE TREE DR
IONIA MI
48846-7506
US

V. Phone/Fax

Practice location:
  • Phone: 616-902-0173
  • Fax:
Mailing address:
  • Phone: 616-902-0173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number6802087245
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: