Healthcare Provider Details

I. General information

NPI: 1265919849
Provider Name (Legal Business Name): ALEXANDER THOMPSON MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 MONROE AVE NW STE 322
GRAND RAPIDS MI
49505-4674
US

IV. Provider business mailing address

1345 MONROE AVE NW STE 322
GRAND RAPIDS MI
49505-4674
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-9550
  • Fax:
Mailing address:
  • Phone: 616-949-9550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801104791
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: