Provider Demographics
NPI:1417415829
Name:BYTWERK, KIMBERLY
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:
Last Name:BYTWERK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 MONROE AVE NW STE 400
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2293
Mailing Address - Country:US
Mailing Address - Phone:616-901-9507
Mailing Address - Fax:
Practice Address - Street 1:250 MONROE AVE NW STE 400
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2293
Practice Address - Country:US
Practice Address - Phone:616-901-9507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015831101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional