MEDICARE: MINNIETALKS2YOU

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	103TP2701X	Group Psychotherapy Psychologist
3	104100000X	Social Worker
4	1041S0200X	School Social Worker
5	251B00000X	Case Management Agency
6	251C00000X	Developmentally Disabled Services Day Training Agency
7	251E00000X	Home Health Agency
8	251S00000X	Community/Behavioral Health Agency
9	261QD1600X	Developmental Disabilities Clinic/Center
10	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
11	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
12	385HR2065X	Child Physical Disabilities Respite Care
13	1041C0700X	Clinical Social Worker

NPI Number	:	1659134005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINNIETALKS2YOU

Provider Business Mailing Address
First Line	:	166 MAPLE ST
Second Line	:
City	:	SPARTA
State	:	MI
Zip	:	49345-1310
Country	:	US
Telephone Number	:	616-799-4419
Fax Number	:	616-205-5017

Provider Business Practice Location Address
First Line	:	168 MAPLE ST
Second Line	:
City	:	SPARTA
State	:	MI
Zip	:	49345-1310
Country	:	US
Telephone Number	:	616-799-4419
Fax Number	:	616-205-5017

Authorized Official
Title or Position	:	COMMUNICATION TRUSTEE OFFICER
Name	:	MRS. MINNETTE KATHLEEN GAMBLE
Credential	:	PHD, LMSW
Telephone Number	:	616-799-4419

Provider Enumeration Date	:	01/30/2024
Last Update Date	:	01/30/2024

168 MAPLE ST
SPARTA, MI
49345-1310

Practice Phone: 616-685-0985
Practice Fax: