MEDICARE: DEBORAH DENISE SPOORS MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	6301007767	MI

General Provider Information

NPI Number	:	1306996467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH DENISE SPOORS MA

Provider Business Mailing Address
First Line	:	8342 HIAWATHA DR
Second Line	:
City	:	WEST OLIVE
State	:	MI
Zip	:	49460-9511
Country	:	US
Telephone Number	:	616-638-4671
Fax Number	:	616-451-3070

Provider Business Practice Location Address
First Line	:	1514 WEALTHY ST SE
Second Line	:	SUITE 260
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49506-2755
Country	:	US
Telephone Number	:	616-451-3008
Fax Number	:	616-451-3070

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	07/08/2007

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