Provider Demographics
NPI:1043671027
Name:VANDEKREKE, MICHAEL (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:VANDEKREKE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3923 MERCY DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-3173
Mailing Address - Country:US
Mailing Address - Phone:815-344-5061
Mailing Address - Fax:815-344-5072
Practice Address - Street 1:3923 MERCY DRIVE
Practice Address - Street 2:SUITE F
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-3173
Practice Address - Country:US
Practice Address - Phone:815-344-5061
Practice Address - Fax:815-344-5072
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490095061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical