Provider Demographics
NPI:1053169136
Name:KOPITSCH, WENDY S (LLMSW)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:S
Last Name:KOPITSCH
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 PINERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2420
Mailing Address - Country:US
Mailing Address - Phone:517-749-9811
Mailing Address - Fax:
Practice Address - Street 1:509 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1400
Practice Address - Country:US
Practice Address - Phone:616-202-2138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511179881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical