Crystal Polderdyke, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801089749 Issued in MI

Practice address

6555 15 Mile Rd
Sterling Heights, MI 48312-4511

Phone

(586) 274-0200

NPI assigned

Dec 1, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Crystal Grammatico Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1228089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362960000000",
    "number": "1164677472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6555 15 MILE RD",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483124511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6555 15 MILE RD",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483124511",
            "telephone_number": "586-274-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLDERDYKE",
        "first_name": "CRYSTAL",
        "name_prefix": "Mrs.",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-12-01",
        "last_updated": "2013-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801089749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CRYSTAL",
            "last_name": "GRAMMATICO",
            "credential": "LMSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Plymouth Physical Therapy Specialists Limited Partnership
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• Kimberly Marie Poirier, LMSW
• Eileen M. Pokriefka, D.O.
• Catherine Poleski
• Sarah Polina, PHAMD
• Carolina H Poliss, O.D.
• Leonard B. Pollack, M.D.
• Danielle Polley, OTRL

• Clinical Social Worker in Sterling Heights, MI
• Providers in Sterling Heights, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.