MEDICARE: CINDY L HANER VELZEN LMSW LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker		MI

General Provider Information

NPI Number	:	1023486081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CINDY L HANER VELZEN LMSW LLC

Provider Business Mailing Address
First Line	:	233 MADISON AVE SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-4615
Country	:	US
Telephone Number	:	616-915-5543
Fax Number	:	616-949-9115

Provider Business Practice Location Address
First Line	:	3180 E PARIS AVE SE
Second Line	:
City	:	KENTWOOD
State	:	MI
Zip	:	49512-1926
Country	:	US
Telephone Number	:	616-949-9006
Fax Number	:	616-949-9115

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER
Name	:	MS. CINDY L HANER VELZEN
Credential	:	LMSW
Telephone Number	:	616-949-9006

Provider Enumeration Date	:	09/08/2015
Last Update Date	:	09/21/2015

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