MEDICARE: SJR THERAPY PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1639957129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SJR THERAPY PLLC

Provider Business Mailing Address
First Line	:	547 GLENWOOD AVE SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49506-2702
Country	:	US
Telephone Number	:	616-403-4435
Fax Number	:

Provider Business Practice Location Address
First Line	:	547 GLENWOOD AVE SE # 49506
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49506-2702
Country	:	US
Telephone Number	:	616-403-4435
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	MRS. SARAH JEAN RIEMERSMA
Credential	:	LMSW, CAADC
Telephone Number	:	616-403-4435

Provider Enumeration Date	:	09/18/2023
Last Update Date	:	09/18/2023

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