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General NPI Number Information
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NPI Number | 1467590729
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Entity Type | Individual
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Provider Name | ROBERT JOHN OOM BA LBSW
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Gender | Male
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 04/16/2015
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Provider Practice Location Address
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Address Line | 3241 30TH SW
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City | GRANDVILLE
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State | MI
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Zip | 49418-1427
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Country | US
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Telephone | 616-307-0600
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Fax | 616-328-6588
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Provider Business Mailing Address
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Address Line | 3241 30TH ST SW
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City | GRANDVILLE
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State | MI
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Zip | 49418-1427
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Country | US
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Telephone | 616-249-3518
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6802079625
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License Number State | MI
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