Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ethan Pemberton

Individual provider Clinical Social Worker · NPI 1306486204

Ethan Pemberton is a Clinical Social Worker in Grand Rapids, Michigan. Practices as a sole proprietor. Licensed in Michigan.

Licensed in
MI
In the registry since
2020

Practice location Address checks out

206 Fuller Ave SE
Grand Rapids, MI 49506-1638
Phone: (810) 347-2159
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X (MI)

Record details

NPI number1306486204
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJanuary 9, 2020
Last updated in NPPESJune 12, 2026
Certification dateJune 12, 2026

Other providers in Grand Rapids