Healthcare Provider Details

I. General information

NPI: 1679196968
Provider Name (Legal Business Name): MARIAN HEYKOOP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 PECK ST
MUSKEGON MI
49441-2158
US

IV. Provider business mailing address

310 OAKHILL DR
MUSKEGON MI
49442-1342
US

V. Phone/Fax

Practice location:
  • Phone: 231-724-3517
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: