MEDICARE: NURTURE & THRIVE LLC

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	235Z00000X	Speech-Language Pathologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881453868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NURTURE & THRIVE LLC

Provider Business Mailing Address
First Line	:	1725 BOSTON ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49506-4461
Country	:	US
Telephone Number	:	786-877-5679
Fax Number	:

Provider Business Practice Location Address
First Line	:	1725 BOSTON ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49506-4461
Country	:	US
Telephone Number	:	786-877-5679
Fax Number	:

Authorized Official
Title or Position	:	ORGANIZER
Name	:	JESSICA EVANS
Credential	:	CCC-SLP
Telephone Number	:	786-877-5679

Provider Enumeration Date	:	03/13/2024
Last Update Date	:	10/17/2024

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Directions to “NURTURE & THRIVE LLC ” Practice Location

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