Individual
BERGAN JOHANNA BOLTHOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1055 GEZON PKWY SW, WYOMING, MI 49509-9542
(616) 773-2908
Mailing address
180 HERON DR NW APT 203F, GRAND RAPIDS, MI 49534-1587
(616) 915-1485
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6851120274
MI
Other
Enumeration date
06/11/2025
Last updated
06/11/2025
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