Individual provider Active NPI

Janet Stark, LLMSW

  • Clinical Social Worker
  • Grandville, MI
National Provider Identifier
1720715220
Registry record updated Aug 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6851115339 Issued in MI
Practice address
3181 Prairie St SW Ste 114
Grandville, MI 49418-2097
Phone
(616) 483-0335
NPI assigned
Aug 4, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6851115339 MI Primary

Addresses

Primary practice location

3181 Prairie St SW Ste 114
Grandville, MI 49418-2097

Mailing address

6111 Summerhill CT
Hudsonville, MI 49426-8913

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Jan 9, 2026 through Jan 9, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
6851115339MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Remembered Knowing Therapy LLC CurrentSince Aug 7, 2022 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1659571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659571200000",
    "number": "1720715220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6111 SUMMERHILL CT",
            "city": "HUDSONVILLE",
            "state": "MI",
            "postal_code": "494268913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3181 PRAIRIE ST SW STE 114",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494182097",
            "telephone_number": "616-483-0335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARK",
        "first_name": "JANET",
        "credential": "LLMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-04",
        "last_updated": "2022-08-04",
        "certification_date": "2022-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6851115339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grandville, MI

Sources for this page

Verify at the official NPI Registry.