Provider Demographics
NPI:1093360158
Name:HYSON, MANDI RAE (LMSW)
Entity Type:Individual
Prefix:
First Name:MANDI
Middle Name:RAE
Last Name:HYSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7189 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-7105
Mailing Address - Country:US
Mailing Address - Phone:616-214-5181
Mailing Address - Fax:
Practice Address - Street 1:4565 WILSON AVE SW STE 1A
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2371
Practice Address - Country:US
Practice Address - Phone:616-591-9000
Practice Address - Fax:616-591-9060
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical