Healthcare Provider Details

I. General information

NPI: 1669529418
Provider Name (Legal Business Name): SHELLY G WOERTINK LMCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 E CHART ST
PLAINWELL MI
49080-1768
US

IV. Provider business mailing address

306 HOLLY ST SW
WYOMING MI
49548-4247
US

V. Phone/Fax

Practice location:
  • Phone: 269-685-6363
  • Fax: 269-685-5995
Mailing address:
  • Phone: 616-532-1815
  • Fax: 616-532-1815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801081725
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: