Provider Demographics
NPI:1396518544
Name:SCHROUDER, STEPHEN GREGORY
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:GREGORY
Last Name:SCHROUDER
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 1:1561 TEXAS ST NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544-1760
Mailing Address - Country:US
Mailing Address - Phone:616-745-3650
Mailing Address - Fax:
Practice Address - Street 1:39465 W 14 MILE RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-1600
Practice Address - Country:US
Practice Address - Phone:877-906-9699
Practice Address - Fax:888-483-0118
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010867901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical