1730795816 NPI number — MRS. ELIZABETH ANNE MAHER LMSW, CLINICAL

Table of content: MRS. ELIZABETH ANNE MAHER LMSW, CLINICAL (NPI 1730795816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730795816 NPI number — MRS. ELIZABETH ANNE MAHER LMSW, CLINICAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAHER
Provider First Name:
ELIZABETH
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW, CLINICAL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VOSKUIL
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730795816
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1519 PONTIAC RD SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49506-3367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-818-8481
Provider Business Mailing Address Fax Number:
616-361-3492

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1519 PONTIAC RD SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49506-3367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-818-8481
Provider Business Practice Location Address Fax Number:
616-361-3492
Provider Enumeration Date:
09/23/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6801086681 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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