Organization
D.A. BLODGETT - ST. JOHN'S
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BENJAMIN JON BROWER MSW, LMSW (KSSN SITE TEAM CLINICIAN)
(616) 826-6063
Entity
Organization
Contact information
Practice address
805 LEONARD ST NE, GRAND RAPIDS, MI 49503-1138
(616) 451-2021
Mailing address
805 LEONARD ST NE, GRAND RAPIDS, MI 49503-1138
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
6801088412
MI
Other
Enumeration date
10/04/2010
Last updated
10/04/2010
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