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General NPI Number Information
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NPI Number | 1306738299
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Entity Type | Individual
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Provider Name | BRYCE STOCKSLAGER
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Gender | Male
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Dates
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Enumeration Date | 07/16/2025
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 238 HOOVER BLVD STE 10
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City | HOLLAND
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State | MI
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Zip | 49423-3755
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Country | US
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Telephone | 616-591-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 4160 WHITE OAK ST SW UNIT 25101
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City | WYOMING
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State | MI
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Zip | 49418-9534
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Country | US
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Telephone | 602-920-5224
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6352001161
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License Number State | MI
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