Healthcare Provider Details

I. General information

NPI: 1972122182
Provider Name (Legal Business Name): ZACHARY STEPANOVICH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 IONIA AVE NW
GRAND RAPIDS MI
49503-1020
US

IV. Provider business mailing address

1131 IONIA AVE NW
GRAND RAPIDS MI
49503-1020
US

V. Phone/Fax

Practice location:
  • Phone: 269-381-3700
  • Fax: 269-381-3810
Mailing address:
  • Phone: 616-336-3909
  • Fax: 616-259-7909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851118050
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: