Healthcare Provider Details

I. General information

NPI: 1245143353
Provider Name (Legal Business Name): LINDSEY MARIE ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

862 CRAHEN AVE NE
GRAND RAPIDS MI
49525-3477
US

IV. Provider business mailing address

9710 11 MILE RD NE
ROCKFORD MI
49341-9366
US

V. Phone/Fax

Practice location:
  • Phone: 616-410-4844
  • Fax:
Mailing address:
  • Phone: 616-901-3150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101003396
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: