Healthcare Provider Details

I. General information

NPI: 1639957129
Provider Name (Legal Business Name): SJR THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 09/18/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

547 GLENWOOD AVE SE # 49506
GRAND RAPIDS MI
49506-2702
US

IV. Provider business mailing address

547 GLENWOOD AVE SE
GRAND RAPIDS MI
49506-2702
US

V. Phone/Fax

Practice location:
  • Phone: 616-403-4435
  • Fax:
Mailing address:
  • Phone: 616-403-4435
  • Fax:

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: MRS. SARAH JEAN RIEMERSMA
Title or Position: THERAPIST
Credential: LMSW, CAADC
Phone: 616-403-4435