MEDICARE: MS. KAREN A BYLSMA LCSW

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	1041C0700X	Clinical Social Worker	6801014567	MI

General Provider Information

NPI Number	:	1841448461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN A BYLSMA LCSW

Provider Business Mailing Address
First Line	:	3124 N WELLNESS DR
Second Line	:	SUITE 30
City	:	HOLLAND
State	:	MI
Zip	:	49424-8121
Country	:	US
Telephone Number	:	616-786-3304
Fax Number	:	616-786-3375

Provider Business Practice Location Address
First Line	:	3124 N WELLNESS DR
Second Line	:	SUITE 30
City	:	HOLLAND
State	:	MI
Zip	:	49424-8121
Country	:	US
Telephone Number	:	616-786-3304
Fax Number	:	616-786-3375

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

Provider Enumeration Date	:	09/08/2008
Last Update Date	:	11/13/2009

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