Healthcare Provider Details

I. General information

NPI: 1235521063
Provider Name (Legal Business Name): CHERYL LYNN DUDGEON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MONROE AVE NW STE 300
GRAND RAPIDS MI
49503-1445
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:
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:
Title or Position:
Credential:
Phone: