Healthcare Provider Details

I. General information

NPI: 1356361463
Provider Name (Legal Business Name): DIANA SUSANNE ALBERS MS, AT, ATC, LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DIANA SUSANNE BRAY ATC

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

486 CENTURY LN
HOLLAND MI
49423-4295
US

IV. Provider business mailing address

10224 HOLIDAY DR
ZEELAND MI
49464-6916
US

V. Phone/Fax

Practice location:
  • Phone: 616-298-2731
  • Fax:
Mailing address:
  • Phone: 616-834-1787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851118182
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number6851118182
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: