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General NPI Number Information
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NPI Number | 1205676103
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Entity Type | Individual
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Provider Name | CAITLIN TREZISE
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Gender | Female
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Dates
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Enumeration Date | 05/29/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 7791 BYRON CENTER AVE SW
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City | BYRON CENTER
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State | MI
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Zip | 49315-8412
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Country | US
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Telephone | 616-499-4711
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Fax |
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Provider Business Mailing Address
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Address Line | 2850 SWANSEA DR SE # QC2850
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-8045
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Country | US
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Telephone |
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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 | 6801118439
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License Number State | MI
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