Individual
ELIZABETH TIETEMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3215 EAGLE CREST DR NE, GRAND RAPIDS, MI 49525-7005
(616) 588-2737
Mailing address
3215 EAGLE CREST DR NE, GRAND RAPIDS, MI 49525-7005
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6851102526
MI
Other
Enumeration date
01/18/2022
Last updated
01/18/2022
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