Individual
CARLY PETROELJE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
790 FULLER AVE NE, GRAND RAPIDS, MI 49503-1918
(616) 336-3909
Mailing address
790 FULLER AVE NE, GRAND RAPIDS, MI 49503-1918
(616) 336-3909
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801091613
MI
Other
Enumeration date
06/17/2015
Last updated
06/17/2015
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