MEDICARE: MS. LAURA LEA DEGRAAF MA, LLP

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	6301009698	MI

General Provider Information

NPI Number	:	1861519357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA LEA DEGRAAF MA, LLP

Provider Business Mailing Address
First Line	:	1115 BALL AVE NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-5904
Country	:	US
Telephone Number	:	616-459-7215
Fax Number	:	616-451-0020

Provider Business Practice Location Address
First Line	:	1115 BALL AVE NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-5904
Country	:	US
Telephone Number	:	616-460-5049
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	12/11/2025

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