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NPI Code Detail

MEDICARE: MARY R WHITCOMB LLMSW

MEDICARE: MARY R WHITCOMB 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
1104100000XSocial Worker6802086746MI

General Provider Information

NPI Number : 1568703429
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY R WHITCOMB LLMSW
Provider Business Mailing Address
First Line : 300 68TH ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49548-6927
Country : US
Telephone Number : 616-258-7599
Fax Number :
Provider Business Practice Location Address
First Line : 320 COMMERCE AVE SW
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-4101
Country : US
Telephone Number : 616-258-7599
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2013
Last Update Date : 03/30/2015

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