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General NPI Number Information
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NPI Number | 1932758117
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Entity Type | Organization
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Legal Business Name | CRISTINA STAUFFER, LLC
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 09/10/2019
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Provider Practice Location Address
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Address Line | 233 FULTON ST E STE 226
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-3262
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Country | US
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Telephone | 616-581-4967
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Fax |
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Provider Business Mailing Address
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Address Line | 1655 RIVA RIDGE DR SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-8221
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Country | US
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Telephone | 616-581-4967
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CRISTINA STAUFFER
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Credential | LMSW
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Telephone | 616-581-4967
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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 |
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License Number State |
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