MEDICARE: HEIDI CHRISTINE KALTENBACHER MSW

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	6801084542	MI

General Provider Information

NPI Number	:	1457886202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI CHRISTINE KALTENBACHER MSW

Provider Business Mailing Address
First Line	:	2461 CEDAR CREST DR NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-1204
Country	:	US
Telephone Number	:	616-901-4824
Fax Number	:

Provider Business Practice Location Address
First Line	:	456 PLYMOUTH AVE NE STE A
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-6053
Country	:	US
Telephone Number	:	616-901-4824
Fax Number	:

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

Provider Enumeration Date	:	04/28/2017
Last Update Date	:	06/20/2022

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