Provider Demographics
NPI:1346652492
Name:WU, TREVOR CHUANGKUO (PHD)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:CHUANGKUO
Last Name:WU
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:CHUANGKUO
Other - Middle Name:
Other - Last Name:WU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1900 44TH ST SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-5008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:220 CHERRY ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4608
Practice Address - Country:US
Practice Address - Phone:616-685-5050
Practice Address - Fax:616-685-8962
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X
MI6301015974103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist