Healthcare Provider Details

I. General information

NPI: 1932456076
Provider Name (Legal Business Name): LEONARD O UCHENDU LLMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 EOLA ST SE
GRAND RAPIDS MI
49507-3429
US

IV. Provider business mailing address

251 EOLA ST SE
GRAND RAPIDS MI
49507-3429
US

V. Phone/Fax

Practice location:
  • Phone: 616-241-5880
  • Fax:
Mailing address:
  • Phone: 616-241-5880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801094635
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: