Provider Demographics
NPI:1144415027
Name:VANDER SCHEL, CONNIE M (MSW, LMSW)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:M
Last Name:VANDER SCHEL
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 LEONARD ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-5650
Mailing Address - Country:US
Mailing Address - Phone:616-956-1122
Mailing Address - Fax:616-956-8033
Practice Address - Street 1:1870 LEONARD ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-5650
Practice Address - Country:US
Practice Address - Phone:616-956-1122
Practice Address - Fax:616-956-8033
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010180941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN20450038Medicare PIN