Provider Demographics
NPI:1114696838
Name:VANDERBAND, JANNA (ATR-P)
Entity Type:Individual
Prefix:
First Name:JANNA
Middle Name:
Last Name:VANDERBAND
Suffix:
Gender:F
Credentials:ATR-P
Other - Prefix:
Other - First Name:JANNA
Other - Middle Name:
Other - Last Name:LUDEMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1011 11TH ST NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-4311
Mailing Address - Country:US
Mailing Address - Phone:616-821-8274
Mailing Address - Fax:
Practice Address - Street 1:3800 LAKE MICHIGAN DR NW STE 103
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-4583
Practice Address - Country:US
Practice Address - Phone:616-805-3680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty