Healthcare Provider Details

I. General information

NPI: 1003282724
Provider Name (Legal Business Name): RECLAIM LIFE THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MONROE AVE NW STE 308
GRAND RAPIDS MI
49503-1451
US

IV. Provider business mailing address

800 MONROE AVE NW STE 308
GRAND RAPIDS MI
49503-1451
US

V. Phone/Fax

Practice location:
  • Phone: 616-309-0107
  • Fax: 616-825-6185
Mailing address:
  • Phone: 616-309-0107
  • Fax: 616-825-6185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801092199
License Number StateMI

VIII. Authorized Official

Name: CHERYL L DUDGEON
Title or Position: THERAPIST/OWNER
Credential: LMSW
Phone: 616-309-0107