Healthcare Provider Details

I. General information

NPI: 1710633862
Provider Name (Legal Business Name): CRYSTAL TRUONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 BURTON ST SE STE 210
GRAND RAPIDS MI
49506-4669
US

IV. Provider business mailing address

4129 N CASTLE RIDGE DR SE APT 271
GRAND RAPIDS MI
49508-8860
US

V. Phone/Fax

Practice location:
  • Phone: 616-236-3600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801121552
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801121552
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: