Basic Information
| Provider Information | |||||||||
| NPI: | 1346834579 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAPUT | ||||||||
| FirstName: | NICHOLE | ||||||||
| MiddleName: | ADELINE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 68TH ST SE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495486927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6164555000 | ||||||||
| FaxNumber: | 6164555960 | ||||||||
| Practice Location | |||||||||
| Address1: | 11652 W GRAND RIVER AVE | ||||||||
| Address2: | |||||||||
| City: | LOWELL | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493318465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6168975900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2021 | ||||||||
| LastUpdateDate: | 11/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 171M00000X | 6801109662 | MI | N | Other Service Providers | Case Manager/Care Coordinator | 104100000X | 6851109662 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.