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General NPI Number Information
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NPI Number | 1710517354
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Entity Type | Individual
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Provider Name | AMY MARIE GELDERSMA LMSW
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Gender | Female
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Dates
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Enumeration Date | 01/23/2020
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 1050 W WESTERN AVE STE 400
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City | MUSKEGON
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State | MI
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Zip | 49441-1666
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Country | US
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Telephone | 231-728-3442
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Fax |
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Provider Business Mailing Address
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Address Line | 3509 MOORE RD
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City | BAILEY
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State | MI
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Zip | 49303-9602
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Country | US
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Telephone | 231-728-3442
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801096601
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License Number State | MI
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