Healthcare Provider Details

I. General information

NPI: 1467178475
Provider Name (Legal Business Name): ASU ALAIN ASHER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 36TH ST SE
GRAND RAPIDS MI
49512-2810
US

IV. Provider business mailing address

1050 36TH ST SE
GRAND RAPIDS MI
49508-5580
US

V. Phone/Fax

Practice location:
  • Phone: 616-831-5646
  • Fax:
Mailing address:
  • Phone: 616-644-8323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851115549
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: