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General NPI Number Information
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NPI Number | 1417648908
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Entity Type | Organization
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Legal Business Name | HEATHER NITZKI LLC
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Dates
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Enumeration Date | 05/16/2023
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Last Update Date | 05/16/2023
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Provider Practice Location Address
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Address Line | 5060 CASCADE RD SE STE D
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-3808
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Country | US
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Telephone | 331-625-3796
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Fax |
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Provider Business Mailing Address
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Address Line | 5060 CASCADE RD SE STE D
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-3808
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Country | US
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Telephone | 331-625-3796
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | HEATHER NITZKI
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Credential |
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Telephone | 331-625-3796
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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