Provider Demographics
NPI:1326415738
Name:BETLEJEWSKI, DAVID (MBA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BETLEJEWSKI
Suffix:
Gender:M
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 PECK ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-2507
Mailing Address - Country:US
Mailing Address - Phone:231-747-8650
Mailing Address - Fax:231-395-5915
Practice Address - Street 1:1735 PECK ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-2507
Practice Address - Country:US
Practice Address - Phone:231-747-8650
Practice Address - Fax:231-395-5915
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker