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NPI Code Detail

MEDICARE: MS. VICKI MARIE MAKLEY SOCIAL WORKER

MEDICARE: MS. VICKI MARIE MAKLEY SOCIAL WORKER
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 Worker077889MI

General Provider Information

NPI Number : 1619031150
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. VICKI MARIE MAKLEY SOCIAL WORKER
Provider Business Mailing Address
First Line : 953 ARLINGTON ST NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49505-3803
Country : US
Telephone Number : 616-361-0419
Fax Number :
Provider Business Practice Location Address
First Line : 1256 WALKER AVE NW
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49504-4067
Country : US
Telephone Number : 616-235-2910
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2006
Last Update Date : 07/08/2007

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Directions to “ MS. VICKI MARIE MAKLEY SOCIAL WORKER” Practice Location

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