Provider Demographics
NPI:1639508989
Name:GIERSZEWSKI, ANGELIQUE S (LMSW)
Entity type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:S
Last Name:GIERSZEWSKI
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 1:320 COMMERCE AVE SW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4101
Mailing Address - Country:US
Mailing Address - Phone:616-258-7599
Mailing Address - Fax:616-222-4571
Practice Address - Street 1:320 COMMERCE AVE SW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4101
Practice Address - Country:US
Practice Address - Phone:616-258-7599
Practice Address - Fax:616-222-4571
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4521104100000X
MI68010997501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker