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General NPI Number Information
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NPI Number | 1992189344
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Entity Type | Individual
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Provider Name | ANNE GRUBER-BARTLEY
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Gender | Female
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 05/22/2020
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Provider Practice Location Address
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Address Line | 5270 NORTHLAND DR NE STE B
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-1073
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Country | US
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Telephone | 616-326-5672
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Fax |
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Provider Business Mailing Address
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Address Line | 701 HAYES DR
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City | BAY CITY
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State | MI
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Zip | 48708-6801
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Country | US
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Telephone | 720-939-9089
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LCSW00001976
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801100685
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License Number State | MI
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