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General NPI Number Information
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NPI Number | 1194530584
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Entity Type | Individual
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Provider Name | CHRISTY J WIERENGA LMSW
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Gender | Female
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Dates
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Enumeration Date | 02/11/2025
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 546 76TH ST SW
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City | BYRON CENTER
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State | MI
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Zip | 49315-8307
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Country | US
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Telephone | 616-878-6634
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Fax |
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Provider Business Mailing Address
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Address Line | 2037 CAYUGA ST NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49504-5917
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Country | US
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Telephone | 616-318-9996
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801091620
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License Number State | MI
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