Active NPI
Amy Modlin, LMSW, CAADC
- Clinical Social Worker
- Grand Rapids, MI
National Provider Identifier
1750511036
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 106691
- Practice address
- 401 West Fulton St
Grand Rapids, MI 49504 - Phone
- (616) 610-0591
- NPI assigned
- Jul 21, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 2028 | NH | |
| Clinical Social Worker | 1041C0700X | 6801090715 | MI | |
| Clinical Social Worker | 1041C0700X | 106691 | CA | Primary |
Addresses
Primary practice location
401 West Fulton St
Grand Rapids, MI 49504
Mailing address
401 West Fulton St
Grand Rapids, MI 49504
Phone (616) 610-0591
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801090715 | MI | MD | Clinical Social Worker |
| 2028 | NH | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674691200000",
"number": "1750511036",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 WEST FULTON ST",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "49504",
"telephone_number": "616-610-0591"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 WEST FULTON ST",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "49504",
"telephone_number": "616-610-0591"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MODLIN",
"first_name": "AMY",
"credential": "LMSW, CAADC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-07-21",
"last_updated": "2023-01-26",
"certification_date": "2023-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NH",
"license": "2028",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6801090715",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "106691",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.