Healthcare Provider Details

I. General information

NPI: 1760418792
Provider Name (Legal Business Name): SHANE EVAN VER STEEG LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 CASCADE WEST PKWY SE
GRAND RAPIDS MI
49546-2137
US

IV. Provider business mailing address

2611 WASHINGTON STREET
PELLA IA
50219
US

V. Phone/Fax

Practice location:
  • Phone: 616-930-4123
  • Fax: 616-323-3994
Mailing address:
  • Phone: 641-628-9599
  • Fax: 641-621-1493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801099861
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number06425
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: