Provider Demographics
NPI:1346527223
Name:WOLBRINK, GRACE C (MSW)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:C
Last Name:WOLBRINK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5476 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-1529
Mailing Address - Country:US
Mailing Address - Phone:616-299-9698
Mailing Address - Fax:
Practice Address - Street 1:5476 WILSON AVE
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-1529
Practice Address - Country:US
Practice Address - Phone:616-299-9698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL15518571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical