Provider Demographics
NPI:1245471606
Name:WERKHOVEN, SOPHIE ANNA
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:ANNA
Last Name:WERKHOVEN
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 1:3737 LAKE EASTBROOK BLVD SE STE 206
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5944
Mailing Address - Country:US
Mailing Address - Phone:616-255-9090
Mailing Address - Fax:
Practice Address - Street 1:3737 LAKE EASTBROOK BLVD SE STE 206
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5944
Practice Address - Country:US
Practice Address - Phone:616-255-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010854951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical