Healthcare Provider Details

I. General information

NPI: 1003752346
Provider Name (Legal Business Name): ANDESITE GROSSMEYER LLMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: REBEKAH GROSSMEYER

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4572 S HAGADORN RD
EAST LANSING MI
48823-5385
US

IV. Provider business mailing address

904 SADIE CT
MIDLAND MI
48640-7271
US

V. Phone/Fax

Practice location:
  • Phone: 517-481-2133
  • Fax:
Mailing address:
  • Phone: 989-971-8040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851117935
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: