Healthcare Provider Details

I. General information

NPI: 1780928945
Provider Name (Legal Business Name): CHRISTOPHER ROBERT OSTRANDER LLMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2012
Last Update Date: 11/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SHELDON BLVD SE
GRAND RAPIDS MI
49503-4513
US

IV. Provider business mailing address

1644 CLEVELAND AVE SW
WYOMING MI
49509-1371
US

V. Phone/Fax

Practice location:
  • Phone: 616-965-8200
  • Fax:
Mailing address:
  • Phone: 616-690-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801094958
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: