Healthcare Provider Details

I. General information

NPI: 1760697643
Provider Name (Legal Business Name): GORDON IRWIN GREER L.M.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3949 SPARKS DR SE STE. 103
GRAND RAPIDS MI
49546-6110
US

IV. Provider business mailing address

1026 EDNA ST SE
GRAND RAPIDS MI
49507-3705
US

V. Phone/Fax

Practice location:
  • Phone: 616-957-5850
  • Fax: 616-957-5853
Mailing address:
  • Phone: 616-516-9251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801086890
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: