Provider Demographics
NPI:1336792324
Name:HEATHER DUTHLER
Entity type:Organization
Organization Name:HEATHER DUTHLER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUTHLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-889-9098
Mailing Address - Street 1:648 KINNEY AVE NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534
Mailing Address - Country:US
Mailing Address - Phone:616-889-9098
Mailing Address - Fax:
Practice Address - Street 1:648 KINNEY AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534
Practice Address - Country:US
Practice Address - Phone:616-889-9098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-19
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty