Healthcare Provider Details

I. General information

NPI: 1972359842
Provider Name (Legal Business Name): ANGELA CHESSER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MONROE AVE NW STE 320
GRAND RAPIDS MI
49503-1451
US

IV. Provider business mailing address

3056 BARRETT AVE SW
GRANDVILLE MI
49418-1670
US

V. Phone/Fax

Practice location:
  • Phone: 616-965-1173
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ANGELA CHESSER
Title or Position: LMSW CLINICAL THERAPIST
Credential: LMSW
Phone: 269-944-7199