Healthcare Provider Details

I. General information

NPI: 1861519357
Provider Name (Legal Business Name): LAURA LEA DEGRAAF MA, LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 BALL AVE NE
GRAND RAPIDS MI
49505-5904
US

IV. Provider business mailing address

1115 BALL AVE NE
GRAND RAPIDS MI
49505-5904
US

V. Phone/Fax

Practice location:
  • Phone: 616-460-5049
  • Fax:
Mailing address:
  • Phone: 616-459-7215
  • Fax: 616-451-0020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301009698
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: