Provider Demographics
NPI:1063538593
Name:RIDDER, CHARLES HENRY (MSW)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:HENRY
Last Name:RIDDER
Suffix:
Gender:
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 LAKE DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-1674
Mailing Address - Country:US
Mailing Address - Phone:616-459-7215
Mailing Address - Fax:616-451-0020
Practice Address - Street 1:1331 LAKE DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-1674
Practice Address - Country:US
Practice Address - Phone:616-459-7215
Practice Address - Fax:616-451-0020
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010587091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical