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General NPI Number Information
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NPI Number | 1114088218
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Entity Type | Individual
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Provider Name | GEORGE WAYNE ZUIDERVEEN MA
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Gender | Male
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2020 RAYBROOK ST SE SUITE 203
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-7717
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Country | US
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Telephone | 616-285-9600
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Fax |
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Provider Business Mailing Address
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Address Line | 1771 ROGUE RIVER RD NE
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City | BELMONT
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State | MI
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Zip | 49306
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Country | US
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Telephone | 616-447-8100
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801021004
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License Number State | MI
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