Provider Demographics
NPI:1023584778
Name:ZWIERS, GWYN LEIGH
Entity type:Individual
Prefix:
First Name:GWYN
Middle Name:LEIGH
Last Name:ZWIERS
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 1:523 UNION AVE SE APT 3
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5464
Mailing Address - Country:US
Mailing Address - Phone:616-566-8963
Mailing Address - Fax:
Practice Address - Street 1:523 UNION AVE SE APT 3
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-5464
Practice Address - Country:US
Practice Address - Phone:616-566-8963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-21
Last Update Date:2018-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker