Individual
AUSTIN RENEE GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
901 EASTERN AVE NE, GRAND RAPIDS, MI 49503-1201
(616) 204-2032
Mailing address
154 ELMWOOD ST NE, GRAND RAPIDS, MI 49505-6223
(517) 673-5693
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6801093313
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1715928
—
MI
Enumeration date
08/30/2011
Last updated
04/02/2015
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