Provider Demographics
NPI:1275994840
Name:VANDOORNE, CRAIG (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:
Last Name:VANDOORNE
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-9602
Mailing Address - Country:US
Mailing Address - Phone:616-796-9387
Mailing Address - Fax:616-796-9388
Practice Address - Street 1:391 GARDEN AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-9602
Practice Address - Country:US
Practice Address - Phone:616-796-9387
Practice Address - Fax:616-796-9388
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501004726237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist