1447788062 NPI number — LINDSEY SHERD PHD

Table of content: LINDSEY SHERD PHD (NPI 1447788062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447788062 NPI number — LINDSEY SHERD PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHERD
Provider First Name:
LINDSEY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447788062
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2040 RAYBROOK ST SE STE 201-B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49546-7739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-320-4689
Provider Business Mailing Address Fax Number:
616-369-5750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2040 RAYBROOK ST SE STE 201-B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49546-7739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-320-4689
Provider Business Practice Location Address Fax Number:
616-369-5750
Provider Enumeration Date:
05/26/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  6301018042 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 6301017081 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC1900X , with the licence number: 6301018042 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 12345 . This is a "AUTHENTIC CONNECTION PSYCHOLOGICAL SERVICES, LLC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".