Provider Demographics
NPI:1235746041
Name:BOOMGAARD, ALAYNA (LLMSW)
Entity Type:Individual
Prefix:
First Name:ALAYNA
Middle Name:
Last Name:BOOMGAARD
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 1:452 HARDING ST
Mailing Address - Street 2:
Mailing Address - City:CONKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:49403-8720
Mailing Address - Country:US
Mailing Address - Phone:616-550-3803
Mailing Address - Fax:
Practice Address - Street 1:640 3 MILE RD NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-8209
Practice Address - Country:US
Practice Address - Phone:800-693-1916
Practice Address - Fax:248-605-3525
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801107216104100000X, 1041C0700X
MI6801115685104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical