Healthcare Provider Details

I. General information

NPI: 1104840537
Provider Name (Legal Business Name): DAVID CHARLES SCHROEDER LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 EAGLE PARK DR NE STE 107
GRAND RAPIDS MI
49525-7004
US

IV. Provider business mailing address

3355 EAGLE PARK DRIVE NE STE 107
GRAND RAPIDS MI
49525-2458
US

V. Phone/Fax

Practice location:
  • Phone: 616-666-9921
  • Fax: 866-222-8422
Mailing address:
  • Phone: 616-666-9921
  • Fax: 866-222-8422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801097806
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: