Provider Demographics
NPI:1265599450
Name:WARD, RANDALL G (MSW)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:G
Last Name:WARD
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4349 REDSTONE CT SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-3054
Mailing Address - Country:US
Mailing Address - Phone:616-261-0668
Mailing Address - Fax:
Practice Address - Street 1:2520 EASTERN AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-3633
Practice Address - Country:US
Practice Address - Phone:616-243-1822
Practice Address - Fax:616-243-2069
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010851071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical