Provider Demographics
NPI:1497460935
Name:WIERSMA, MELANIE (LLMSW)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:WIERSMA
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 1:6495 GRAN VIA DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9687
Mailing Address - Country:US
Mailing Address - Phone:616-916-7623
Mailing Address - Fax:
Practice Address - Street 1:6495 GRAN VIA DR NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-9687
Practice Address - Country:US
Practice Address - Phone:616-916-7623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511157241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical