Provider Demographics
NPI:1215119417
Name:GROOTERS, RONALD LEE (LMSW, ACSW)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:LEE
Last Name:GROOTERS
Suffix:
Gender:M
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 MEADOW RUN DR SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-9394
Mailing Address - Country:US
Mailing Address - Phone:616-559-5864
Mailing Address - Fax:616-281-6448
Practice Address - Street 1:5420 MEADOW RUN DR SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-9394
Practice Address - Country:US
Practice Address - Phone:616-559-5864
Practice Address - Fax:616-281-6448
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010615111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical