MEDICARE: EASTOWN PSYCHOLOGICAL SERVICES PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1659214591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTOWN PSYCHOLOGICAL SERVICES PLLC

Provider Business Mailing Address
First Line	:	1514 WEALTHY ST SE STE 290
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49506-2755
Country	:	US
Telephone Number	:	616-706-4765
Fax Number	:

Provider Business Practice Location Address
First Line	:	1514 WEALTHY ST SE STE 290
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49506-2755
Country	:	US
Telephone Number	:	616-706-4765
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	KRISTIN ELIZABETH ROBERTS
Credential	:	PHD
Telephone Number	:	616-706-4765

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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