MEDICARE: LEE CHRISTENSEN DECKROW LMSW

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	104100000X	Social Worker	6801063846	MI
2	1041C0700X	Clinical Social Worker	6801063846	MI

General Provider Information

NPI Number	:	1891800868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE CHRISTENSEN DECKROW LMSW

Provider Business Mailing Address
First Line	:	333 BRIDGE ST NW STE 1120
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-5356
Country	:	US
Telephone Number	:	616-805-3660
Fax Number	:	616-805-3631

Provider Business Practice Location Address
First Line	:	1403 60TH ST SE
Second Line	:
City	:	KENTWOOD
State	:	MI
Zip	:	49508-7065
Country	:	US
Telephone Number	:	616-805-3660
Fax Number	:	616-805-3631

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	11/02/2023

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