Provider Demographics
NPI:1386442051
Name:WALSTRA, STEFFANIE (LCSW)
Entity type:Individual
Prefix:
First Name:STEFFANIE
Middle Name:
Last Name:WALSTRA
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:983 SPAULDING AVE SE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-3701
Mailing Address - Country:US
Mailing Address - Phone:616-460-9573
Mailing Address - Fax:
Practice Address - Street 1:983 SPAULDING AVE SE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-3701
Practice Address - Country:US
Practice Address - Phone:616-460-9573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099258031041C0700X
MI68011165881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical