Healthcare Provider Details

I. General information

NPI: 1356356265
Provider Name (Legal Business Name): CRAGWALL & ASSOCIATES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4469 CASCADE RD SE SUITE 4469
GRAND RAPIDS MI
49546-3632
US

IV. Provider business mailing address

4469 CASCADE ROAD SE SUITE 4469
GRAND RAPIDS MI
49546-3632
US

V. Phone/Fax

Practice location:
  • Phone: 616-940-3331
  • Fax: 616-940-1377
Mailing address:
  • Phone: 616-940-3331
  • Fax: 616-940-1377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801011390
License Number StateMI

VIII. Authorized Official

Name: MS. JOAN M STOFFER
Title or Position: OFFICE MANAGER
Credential:
Phone: 616-940-3331