MEDICARE: KATE PRISCILLA VERSLUIS HIGH SCHOOL

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1740012699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATE PRISCILLA VERSLUIS HIGH SCHOOL

Provider Business Mailing Address
First Line	:	3305 3 MILE RD NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-9788
Country	:	US
Telephone Number	:	616-530-2224
Fax Number	:

Provider Business Practice Location Address
First Line	:	3305 3 MILE RD NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-9788
Country	:	US
Telephone Number	:	616-530-2224
Fax Number	:

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

Provider Enumeration Date	:	08/19/2024
Last Update Date	:	05/19/2026

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Directions to “ KATE PRISCILLA VERSLUIS HIGH SCHOOL” Practice Location

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