Individual provider Active NPI

Lee Christensen Deckrow, LMSW

  • Clinical Social Worker
  • Kentwood, MI
National Provider Identifier
1891800868
Registry record updated Nov 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801063846 Issued in MI
Practice address
1403 60TH St SE
Kentwood, MI 49508-7065
Phone
(616) 805-3660
Fax
(616) 805-3631
NPI assigned
Aug 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 6801063846 MI
Clinical Social Worker 1041C0700X 6801063846 MI Primary

Addresses

Primary practice location

1403 60TH St SE
Kentwood, MI 49508-7065

Mailing address

333 Bridge St NW Ste 1120
Grand Rapids, MI 49504-5356
Phone (616) 805-3660

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041213000735 MI Practitioner - Clinical Social Worker 0143287086 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801063846MIMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Virtuwell Therapy, LLC CurrentSince Feb 4, 2024 Accepting new patients
Counseling Center of West Michigan, LLC CurrentSince Oct 3, 2023 Accepting new patients

Locations

333 Bridge St NW
Ste 1120
Grand Rapids, MI 49504
Phone 61680536601005

360 E Beltline Ave NE
Ste 100
Grand Rapids, MI 49506
Phone (616) 566-1021

1403 60th St SE
Kentwood, MI 49508
Phone (616) 485-9561

65 S Main St
Ste A
Rockford, MI 49341

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698883200000",
    "number": "1891800868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 BRIDGE ST NW STE 1120",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495045356",
            "telephone_number": "616-805-3660",
            "fax_number": "616-805-3631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1403 60TH ST SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495087065",
            "telephone_number": "616-805-3660",
            "fax_number": "616-805-3631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECKROW",
        "first_name": "LEE",
        "middle_name": "CHRISTENSEN",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-20",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801063846",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801063846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kentwood, MI

Sources for this page

Verify at the official NPI Registry.