| |
785 W Randall St Ste B, Coopersville, MI 49404-1307 | |
(616) 201-2882 | |
(616) 320-0558 |
Full Name | |
---|---|
Type | Facility |
Speciality | Speech-language Pathologist |
Location | 785 W Randall St Ste B, Coopersville, Michigan |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1407592025 | NPI | - | NPPES |
1740797943 | Medicaid | MI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
235Z00000X | Speech-language Pathologist | (* (Not Available)) | Primary |
Provider Name | Elaina Stewart |
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Provider Type | Practitioner - Qualified Speech Language Pathologist |
Provider Identifiers | NPI Number: 1740797943 PECOS PAC ID: 2567721285 Enrollment ID: I20180125001235 |
Mailing Address | Practice Location Address |
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7340 Water View Ln, Allendale, MI 49401-9656 Ph: () - | 785 W Randall St Ste B, Coopersville, MI 49404-1307 Ph: (616) 201-2882 |