Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 6801088897 | MI |
NPI | 1003162884 |
---|---|
Provider Name | Mrs. Sarah Lynn Bylsma |
First Address | Grand Rapids, MI 49506-1678 |
Second Address | Grand Rapids, MI 49506-1678 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2012 |
Last Update Date | 30/07/2012 |