Provider Demographics
NPI:1558841106
Name:WESSEL, ROBERT J (BS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:WESSEL
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15086 LAKESHORE DR # DT
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-9350
Mailing Address - Country:US
Mailing Address - Phone:616-405-8559
Mailing Address - Fax:
Practice Address - Street 1:15086 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-9350
Practice Address - Country:US
Practice Address - Phone:616-405-8559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician