MEDICARE: ERIN FOSTER-MALL 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
1	1041C0700X	Clinical Social Worker	6851115718	MI
2	1041C0700X	Clinical Social Worker	6801120106	MI

General Provider Information

NPI Number	:	1588355762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN FOSTER-MALL LMSW

Provider Business Mailing Address
First Line	:	2444 PARIS AVE SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49507-3523
Country	:	US
Telephone Number	:	734-478-6291
Fax Number	:

Provider Business Practice Location Address
First Line	:	1115 BALL AVE NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-5904
Country	:	US
Telephone Number	:	616-456-6571
Fax Number	:

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

Provider Enumeration Date	:	05/17/2023
Last Update Date	:	01/22/2026

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