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NPI Code Detail

MEDICARE: MELISSA FISK B.S.W., Q.I.D.P.

MEDICARE:   MELISSA  FISK  B.S.W., Q.I.D.P.
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
1104100000XSocial Worker6802087523MI

General Provider Information

NPI Number : 1346665858
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA FISK B.S.W., Q.I.D.P.
Provider Business Mailing Address
First Line : 1111 40TH ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49508-6084
Country : US
Telephone Number : 616-889-1607
Fax Number : 616-241-6470
Provider Business Practice Location Address
First Line : 1111 40TH ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49508-6084
Country : US
Telephone Number : 616-889-1607
Fax Number : 616-241-6470
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2014
Last Update Date : 06/15/2023

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Directions to “ MELISSA FISK B.S.W., Q.I.D.P.” Practice Location

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