Healthcare Provider Details

I. General information

NPI: 1093855025
Provider Name (Legal Business Name): SHERRY STEENWYK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 E BELTLINE AVE SE STE 102
GRAND RAPIDS MI
49546-7673
US

IV. Provider business mailing address

2025 E BELTLINE AVE SE STE 102
GRAND RAPIDS MI
49546-7673
US

V. Phone/Fax

Practice location:
  • Phone: 616-320-4886
  • Fax:
Mailing address:
  • Phone: 616-320-4886
  • Fax: 616-957-1438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301014852
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: