Provider Demographics
NPI:1053852103
Name:DEVI FONGERS
Entity Type:Organization
Organization Name:DEVI FONGERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMSW
Authorized Official - Prefix:
Authorized Official - First Name:DEVI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FONGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-262-1462
Mailing Address - Street 1:1220 OAKLEIGH RD NW
Mailing Address - Street 2:STE 2
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-2548
Mailing Address - Country:US
Mailing Address - Phone:616-262-1462
Mailing Address - Fax:
Practice Address - Street 1:1220 OAKLEIGH RD NW
Practice Address - Street 2:STE 2
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-2548
Practice Address - Country:US
Practice Address - Phone:616-262-1462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty