Provider Demographics
NPI:1710506753
Name:HANN, EMILY KULKA (LMSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:KULKA
Last Name:HANN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1276
Mailing Address - Country:US
Mailing Address - Phone:616-821-3916
Mailing Address - Fax:
Practice Address - Street 1:18 N 5TH ST
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1276
Practice Address - Country:US
Practice Address - Phone:616-821-3916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010880701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical