MEDICARE: KIRK ANDRIESSEN MSW

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	101YM0800X	Mental Health Counselor	6851103239	MI

General Provider Information

NPI Number	:	1699431775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRK ANDRIESSEN MSW

Provider Business Mailing Address
First Line	:	385 LEONARD ST NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-1129
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3980 CHICAGO DR SW STE 114
Second Line	:
City	:	GRANDVILLE
State	:	MI
Zip	:	49418-1392
Country	:	US
Telephone Number	:	616-209-9295
Fax Number	:

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

Provider Enumeration Date	:	11/12/2021
Last Update Date	:	11/06/2023

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