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NPI Code Detail

MEDICARE: MATTHEW JAMES LAIDLAW LLMSW

MEDICARE: MATTHEW JAMES LAIDLAW LLMSW
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 Worker6851117845MI

General Provider Information

NPI Number : 1437907573
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW JAMES LAIDLAW LLMSW
Provider Business Mailing Address
First Line : 1186 SYCAMORE DR
Second Line :
City : JENISON
State : MI
Zip : 49428-8336
Country : US
Telephone Number : 616-389-4163
Fax Number :
Provider Business Practice Location Address
First Line : 985 PARCHMENT DR SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-3659
Country : US
Telephone Number : 616-425-2412
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2024
Last Update Date : 05/13/2024

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