MEDICARE: SHARON ROSE DEPCINSKI

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	6801077777	MI

General Provider Information

NPI Number	:	1316420045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON ROSE DEPCINSKI

Provider Business Mailing Address
First Line	:	1748 TAMARACK AVE NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-2861
Country	:	US
Telephone Number	:	616-361-7919
Fax Number	:

Provider Business Practice Location Address
First Line	:	1748 TAMARACK AVE NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-2861
Country	:	US
Telephone Number	:	616-361-7919
Fax Number	:

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

Provider Enumeration Date	:	09/09/2018
Last Update Date	:	09/09/2018

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Directions to “ SHARON ROSE DEPCINSKI ” Practice Location

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