Provider Demographics
NPI:1114531589
Name:ELENBAAS, GRACE K (LLMSW)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:K
Last Name:ELENBAAS
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 KALAMAZOO AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-3605
Mailing Address - Country:US
Mailing Address - Phone:616-913-3066
Mailing Address - Fax:616-913-2037
Practice Address - Street 1:4150 KALAMAZOO AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-3605
Practice Address - Country:US
Practice Address - Phone:616-913-3066
Practice Address - Fax:616-913-2037
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011042571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical