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NPI Code Detail

MEDICARE: ASHLYNN MATTINGLY LMSW

MEDICARE: ASHLYNN MATTINGLY 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 Worker6801109095MI

General Provider Information

NPI Number : 1417544487
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLYNN MATTINGLY LMSW
Provider Business Mailing Address
First Line : 2851 CHARLEVOIX DR SE STE 323
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-7092
Country : US
Telephone Number : 616-458-0692
Fax Number : 616-458-8129
Provider Business Practice Location Address
First Line : 2851 CHARLEVOIX DR SE STE 323
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-7092
Country : US
Telephone Number : 616-458-0692
Fax Number : 616-458-8129
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/24/2020
Last Update Date : 03/11/2026

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Directions to “ ASHLYNN MATTINGLY LMSW” Practice Location

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