| Wedgwood Christian Services | |
|
3300 36th St Se Grand Rapids MI 49512-2810 | |
| (616) 942-2110 | |
| (616) 942-0589 |
| Full Name | Wedgwood Christian Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 3300 36th St Se, Grand Rapids, Michigan |
| Authorized Official Name and Position | Daniel T Gowdy (CEO/PRESIDENT) |
| Authorized Official Contact | 6169422110 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wedgwood Christian Services 3300 36th St Se Grand Rapids MI 49512-2810 Ph: (616) 942-2110 | Wedgwood Christian Services 3300 36th St Se Grand Rapids MI 49512-2810 Ph: (616) 942-2110 |
| NPI Number | 1902997224 |
|---|---|
| Provider Enumeration Date | 09/28/2006 |
| Last Update Date | 11/04/2024 |
| Certification Date | 11/04/2024 |
| Medicare PECOS PAC ID | 6305813403 |
|---|---|
| Medicare Enrollment ID | O20040916000460 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902997224 | NPI | - | NPPES |
| Provider Name | Joel M Sanchez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104147511 PECOS PAC ID: 0547415424 Enrollment ID: I20130226000144 |
| Provider Name | Tamra Pell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548405384 PECOS PAC ID: 2961870589 Enrollment ID: I20221201001476 |
| Provider Name | Brina Tiemeyer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932602760 PECOS PAC ID: 2668837196 Enrollment ID: I20230504003154 |
| Provider Name | Michelle M Roberts |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063898658 PECOS PAC ID: 9739536319 Enrollment ID: I20231104000175 |
| Provider Name | Nicholas Bayer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295206936 PECOS PAC ID: 8628427994 Enrollment ID: I20231212001718 |
| Provider Name | Jacklyn F Eding |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609446434 PECOS PAC ID: 2365886587 Enrollment ID: I20240215002924 |
| Provider Name | Christopher S Moon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1689124117 PECOS PAC ID: 6002252202 Enrollment ID: I20240311001563 |
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