Healthcare Provider Details

I. General information

NPI: 1376768978
Provider Name (Legal Business Name): EMILIE DEYOUNG LMSW, ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S STATE ST
ZEELAND MI
49464-1676
US

IV. Provider business mailing address

300 S STATE ST
ZEELAND MI
49464-1676
US

V. Phone/Fax

Practice location:
  • Phone: 616-772-1733
  • Fax: 616-879-0072
Mailing address:
  • Phone: 616-772-1733
  • Fax: 616-879-0072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801068848
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: