Basic Information
| Provider Information | |||||||||
| NPI: | 1164970539 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THURBER-DEGROOT | ||||||||
| FirstName: | DANIELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1939 S DIVISION AVE. | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162473815 | ||||||||
| FaxNumber: | 6162450450 | ||||||||
| Practice Location | |||||||||
| Address1: | 1939 S DIVISION AVE. | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162473815 | ||||||||
| FaxNumber: | 6162450450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2016 | ||||||||
| LastUpdateDate: | 11/09/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801098679 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.