Provider Demographics
NPI:1083982425
Name:VANBECK, JENNIFER M (PSYD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:VANBECK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 NILES AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-1615
Mailing Address - Country:US
Mailing Address - Phone:269-982-7200
Mailing Address - Fax:
Practice Address - Street 1:1901 NILES AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-1615
Practice Address - Country:US
Practice Address - Phone:269-982-7200
Practice Address - Fax:269-982-0202
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019395103TC0700X
MI6301016305103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical