Healthcare Provider Details

I. General information

NPI: 1306996467
Provider Name (Legal Business Name): DEBORAH DENISE SPOORS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 WEALTHY ST SE SUITE 260
GRAND RAPIDS MI
49506-2755
US

IV. Provider business mailing address

8342 HIAWATHA DR
WEST OLIVE MI
49460-9511
US

V. Phone/Fax

Practice location:
  • Phone: 616-451-3008
  • Fax: 616-451-3070
Mailing address:
  • Phone: 616-638-4671
  • Fax: 616-451-3070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301007767
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: