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General NPI Number Information
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NPI Number | 1023566296
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Entity Type | Individual
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Provider Name | SHANDRA STEWART LMSW
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Gender | Female
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Dates
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Enumeration Date | 09/16/2016
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 3124 N WELLNESS DR STE 50
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City | HOLLAND
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State | MI
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Zip | 49424-8121
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Country | US
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Telephone | 616-805-3660
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Fax |
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Provider Business Mailing Address
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Address Line | 333 BRIDGE ST NW STE 1120
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City | GRAND RAPIDS
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State | MI
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Zip | 49504-5356
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Country | US
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Telephone | 616-805-3660
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Fax | 616-805-3631
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801119590
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License Number State | MI
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