Provider Demographics
NPI:1083795520
Name:DELANGE, JANICE M (PHD MSW)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:M
Last Name:DELANGE
Suffix:
Gender:F
Credentials:PHD MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 WEALTHY ST. SE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506
Mailing Address - Country:US
Mailing Address - Phone:616-957-8159
Mailing Address - Fax:616-451-3070
Practice Address - Street 1:1514 WEALTHY ST SE
Practice Address - Street 2:SUITE 260
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-2755
Practice Address - Country:US
Practice Address - Phone:616-451-3008
Practice Address - Fax:616-451-3070
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801066023101YM0800X
WALW00006285101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7744301OtherAETNA ID #
MI243116000OtherMAGELLAN MIS #
MI0894161Medicare ID - Type Unspecified