Organization
D A BLODGETT-ST JOHNS
Active
Other names
D.A. Blodgett For Children
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAMMY SMITH (DIRECTOR OF FINANCE)
(616) 451-2021
Entity
Organization
Contact information
Practice address
2172 DEAN LAKE AVE NE, GRAND RAPIDS, MI 49505-4444
(616) 451-2021
(616) 774-3842
Mailing address
2172 DEAN LAKE AVE NE, GRAND RAPIDS, MI 49505-4444
(616) 451-2021
(616) 774-3842
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CB410201088
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3243343
—
MI
05
—
4486650
—
MI
05
—
4537919
—
MI
Enumeration date
03/13/2007
Last updated
04/26/2023
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