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NPI Code Detail

MEDICARE: JOY LEISE LMSW

MEDICARE: JOY LEISE LMSW
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
11041C0700XClinical Social Worker6801122033MI

General Provider Information

NPI Number : 1215710215
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOY LEISE LMSW
Provider Business Mailing Address
First Line : 300 68TH ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49548-6927
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1870 LEONARD ST NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49505-5650
Country : US
Telephone Number : 616-956-1122
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2023
Last Update Date : 04/07/2026

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