Healthcare Provider Details

I. General information

NPI: 1609730324
Provider Name (Legal Business Name): JOACHEIM PRICE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 E KILGORE RD
PORTAGE MI
49002-0507
US

IV. Provider business mailing address

246 E KILGORE RD
PORTAGE MI
49002-0507
US

V. Phone/Fax

Practice location:
  • Phone: 269-249-7179
  • Fax:
Mailing address:
  • Phone: 269-249-7179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851120991
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: