Provider Demographics
NPI:1922014067
Name:SILVER, WAYNE RUSSELL (MA, LLP, CAADC)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:RUSSELL
Last Name:SILVER
Suffix:
Gender:M
Credentials:MA, LLP, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 CENTURY LN
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4285
Mailing Address - Country:US
Mailing Address - Phone:616-396-2301
Mailing Address - Fax:616-396-8070
Practice Address - Street 1:412 CENTURY LN
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-4285
Practice Address - Country:US
Practice Address - Phone:616-396-2301
Practice Address - Fax:616-396-8070
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011204103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP10D11275OtherBC/BS