Provider Demographics
NPI:1467874883
Name:VANDENBOSCH, TEMITOPE TOGUNDE (LMSW)
Entity Type:Individual
Prefix:
First Name:TEMITOPE
Middle Name:TOGUNDE
Last Name:VANDENBOSCH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:TEMITOPE
Other - Middle Name:
Other - Last Name:TOGUNDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:509 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1400
Mailing Address - Country:US
Mailing Address - Phone:231-335-1465
Mailing Address - Fax:616-607-7322
Practice Address - Street 1:509 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1400
Practice Address - Country:US
Practice Address - Phone:231-335-1465
Practice Address - Fax:616-607-7322
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-21
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010931401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F16408045Medicare PIN