Provider Demographics
NPI:1184789737
Name:GAGE, JOSEPH L (LPN)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:L
Last Name:GAGE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:736 UNION AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1732
Mailing Address - Country:US
Mailing Address - Phone:616-742-0185
Mailing Address - Fax:616-897-5954
Practice Address - Street 1:1450 LEONARD ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-5515
Practice Address - Country:US
Practice Address - Phone:616-774-8789
Practice Address - Fax:616-475-7570
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4703077967164W00000X
MI6031014166103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No164W00000XNursing Service ProvidersLicensed Practical Nurse