Healthcare Provider Details

I. General information

NPI: 1679994503
Provider Name (Legal Business Name): GRAND RAPIDS ELLINGTON ACADEMY OF ARTS & TECHNOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2013
Last Update Date: 12/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BURTON ST SE
GRAND RAPIDS MI
49507-3202
US

IV. Provider business mailing address

600 BURTON ST SE
GRAND RAPIDS MI
49507-3202
US

V. Phone/Fax

Practice location:
  • Phone: 616-241-6300
  • Fax: 616-635-2803
Mailing address:
  • Phone: 616-241-6300
  • Fax: 616-635-2803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA SPRINGER
Title or Position: CEO
Credential:
Phone: 616-551-3049