Stacey Lynne Grody, CTRS

Primary specialty

Recreation TherapistTaxonomy code 225800000X

License

45840 Issued in MI

Practice address

1490 East Beltline Ave SE
Grand Rapids, MI 49506

Phone

(616) 940-0040

NPI assigned

Jan 17, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Stacey Lynne Vanklompenberg Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1484611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604448000000",
    "number": "1619413481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1490 EAST BELTLINE AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49506",
            "telephone_number": "616-940-0040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1490 EAST BELTLINE AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49506",
            "telephone_number": "616-940-0040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRODY",
        "first_name": "STACEY",
        "middle_name": "LYNNE",
        "name_prefix": "Mrs.",
        "credential": "CTRS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-17",
        "last_updated": "2020-11-04",
        "certification_date": "2020-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225800000X",
            "taxonomy_group": "",
            "desc": "Recreation Therapist",
            "state": "MI",
            "license": "45840",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACEY",
            "last_name": "VANKLOMPENBERG",
            "middle_name": "LYNNE",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Gro Optical, LLC
• Gro Optical, LLC
• Emily Rose Grobbel, DPT
• Emily Grochowalski, LMSW
• Daniel Wayne Grode, D.D.S.
• Alyssa Renee Groendyke, PA
• Caitlin Elizabeth Groeneveld, NP
• Kristen Groenhout, PT
• Grace Groessl
• John Paul Grofvert, PHARMD

• Recreation Therapist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Recreation Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2020; 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.