MEDICARE: CATHERINE JO ELMORE

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
2	1041S0200X	School Social Worker

General Provider Information

NPI Number	:	1104654102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE JO ELMORE

Provider Business Mailing Address
First Line	:	16415 BROWN LN
Second Line	:
City	:	SPRING LAKE
State	:	MI
Zip	:	49456-2115
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 S BEACON BLVD # A2
Second Line	:
City	:	GRAND HAVEN
State	:	MI
Zip	:	49417-2178
Country	:	US
Telephone Number	:	616-805-3660
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2024
Last Update Date	:	07/23/2024

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Directions to “ CATHERINE JO ELMORE ” Practice Location

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