Healthcare Provider Details

I. General information

NPI: 1366560922
Provider Name (Legal Business Name): MS. SHANNA NICHOLE STEINBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 36TH ST SE
GRAND RAPIDS MI
49548-2319
US

IV. Provider business mailing address

781 36TH ST SE PO BOX 141
GRAND RAPIDS MI
49548-2319
US

V. Phone/Fax

Practice location:
  • Phone: 616-726-1869
  • Fax: 616-243-2302
Mailing address:
  • Phone: 616-726-1869
  • Fax: 616-243-2302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: