Healthcare Provider Details

I. General information

NPI: 1306373840
Provider Name (Legal Business Name): KRISTEN FABER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1388 BALDWIN ST
JENISON MI
49428-8937
US

IV. Provider business mailing address

4147 SPRINGLINE DR
HUDSONVILLE MI
49426-7825
US

V. Phone/Fax

Practice location:
  • Phone: 616-259-9220
  • Fax:
Mailing address:
  • Phone: 616-328-2583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801098409
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: