Individual provider · Type 1 NPI

Bergan Johanna Bolthouse

Clinical Social Worker · Wyoming, MI

NPI number 1740175512 Active

Practice location

1055 Gezon Pkwy SW
Wyoming, MI 49509-9542

Call (616) 773-2908 Map

Mailing address

180 Heron Dr NW Apt 203F
Grand Rapids, MI 49534-1587

Specialties and licenses

TaxonomyCodeLicense
Clinical Social Worker Primary 1041C0700X6851120274 (MI)

Clinical Social Worker: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpers…

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About NPI 1740175512

Bergan Johanna Bolthouse's National Provider Identifier is 1740175512, issued on Jun 11, 2025. The primary taxonomy on file is Clinical Social Worker (1041C0700X), and the practice location is in Wyoming, MI. The record was last updated on Jun 11, 2025.