Provider Demographics
NPI:1497278212
Name:BOUWKAMP, AMBER (LMSW)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:BOUWKAMP
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 1:100 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:COOPERSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49404-1227
Mailing Address - Country:US
Mailing Address - Phone:616-844-8038
Mailing Address - Fax:
Practice Address - Street 1:221 W WEBSTER AVE # 515
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49440-1294
Practice Address - Country:US
Practice Address - Phone:616-209-8437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-24
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011081871041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical