Healthcare Provider Details

I. General information

NPI: 1316140122
Provider Name (Legal Business Name): STEFF BECK CONDON MSW, LMSW,ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4519 CASCADE RD SE
GRAND RAPIDS MI
49546-3666
US

IV. Provider business mailing address

2124 BOSTON ST SE
EAST GRAND RAPIDS MI
49506-4164
US

V. Phone/Fax

Practice location:
  • Phone: 161-648-1004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801059462
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: