Healthcare Provider Details

I. General information

NPI: 1104708809
Provider Name (Legal Business Name): GRAND RAPIDS NEUROPSYCHOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 COMSTOCK BLVD NE
GRAND RAPIDS MI
49505-3642
US

IV. Provider business mailing address

519 COMSTOCK BLVD NE
GRAND RAPIDS MI
49505-3642
US

V. Phone/Fax

Practice location:
  • Phone: 815-382-3123
  • Fax:
Mailing address:
  • Phone: 815-382-3123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: BRETT S SCHNEIDER
Title or Position: OWNER
Credential: PHD
Phone: 815-382-3123