Susan De Waard, M.A., LLP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301002554 Issued in MI

Practice address

201 Sheldon Blvd SE
Grand Rapids, MI 49503-4513

Phone

(616) 459-4212

Fax

(616) 774-9022

NPI assigned

Nov 21, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Other names 1

• Mrs. Susan De Waard Bruggink Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

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

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    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1215002811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 SHELDON BLVD SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034513",
            "telephone_number": "616-459-4212",
            "fax_number": "616-774-9022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 SHELDON BLVD SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034513",
            "telephone_number": "616-459-4212",
            "fax_number": "616-774-9022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE WAARD",
        "first_name": "SUSAN",
        "name_prefix": "Mrs.",
        "credential": "M.A., LLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-21",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6301002554",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301002554",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "MI",
            "license": "6301002554",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301002554",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "BRUGGINK",
            "middle_name": "DE WAARD",
            "prefix": "MRS.",
            "credential": "M.A., LLP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Aline De Quadros Teixeira, MD
• Jorgelina T. De Sanctis, MD
• Trevor Lee De Sibour, MD
• Lara De Stefano, MD
• Brian J De Vos, MSW
• Craig A De Witt, PSY.D.
• Daniel J De Witt, PSY.D.
• De Young Chiropractic, P.C.
• Aaron Robert De Young, D.C.
• Gretchen Elise De Young, D.C.

• Clinical Psychologist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.