Provider Demographics
NPI:1194562819
Name:KRZEWSKI, TEAGUE ANTHONY
Entity type:Individual
Prefix:
First Name:TEAGUE
Middle Name:ANTHONY
Last Name:KRZEWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 AWIXA ST NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-7714
Mailing Address - Country:US
Mailing Address - Phone:616-293-5747
Mailing Address - Fax:
Practice Address - Street 1:1690 AWIXA ST NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-7714
Practice Address - Country:US
Practice Address - Phone:616-293-5747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker