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NPI Code Detail

MEDICARE: MISS STEPHANIE HILLEBRAND LMSW

MEDICARE: MISS STEPHANIE HILLEBRAND 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
11041C0700XClinical Social Worker6801092720MI

General Provider Information

NPI Number : 1619392404
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS STEPHANIE HILLEBRAND LMSW
Provider Business Mailing Address
First Line : 300 68TH ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49548-6927
Country : US
Telephone Number : 616-455-5000
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 : 03/03/2014
Last Update Date : 09/03/2024

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