Provider Demographics
NPI:1811604580
Name:KOOIENGA, EMILY HOPE
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:HOPE
Last Name:KOOIENGA
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 1:1200 52ND ST SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-9538
Mailing Address - Country:US
Mailing Address - Phone:616-826-0364
Mailing Address - Fax:
Practice Address - Street 1:1200 52ND ST SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-9538
Practice Address - Country:US
Practice Address - Phone:616-826-0364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011140921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical