Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 6802087518 | MI |
NPI | 1003375775 |
---|---|
Provider Name | Terri A. Hummel |
First Address | Grand Rapids, MI 49507 |
Second Address | Grand Rapids, MI 49507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2019 |
Last Update Date | 13/03/2019 |