Provider Demographics
NPI:1932276037
Name:HOEKSTRA, MARY (LMSW CAAC ACSW BCD)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:HOEKSTRA
Suffix:
Gender:F
Credentials:LMSW CAAC ACSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W PATERSON ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-2557
Mailing Address - Country:US
Mailing Address - Phone:269-343-2641
Mailing Address - Fax:269-349-0419
Practice Address - Street 1:117 W PATERSON ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-2557
Practice Address - Country:US
Practice Address - Phone:269-343-2641
Practice Address - Fax:269-349-4373
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010652191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI27898OtherABECSW
MICERT 200657OtherMCBAP
MICERT 200657OtherMCBAP