Provider Demographics
NPI:1114782646
Name:BROWN-HOLZGEN, SUMMER (LLMSW)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:
Last Name:BROWN-HOLZGEN
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLMSW
Mailing Address - Street 1:4519 CASCADE RD SE STE 6
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8319
Mailing Address - Country:US
Mailing Address - Phone:616-209-8805
Mailing Address - Fax:
Practice Address - Street 1:4519 CASCADE RD SE STE 6
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8319
Practice Address - Country:US
Practice Address - Phone:616-209-8805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511175391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical