Provider Demographics
NPI:1467983478
Name:VANDERWEEL, BAILEY (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:BAILEY
Middle Name:
Last Name:VANDERWEEL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9359 HARBOR COVE CIR APT 254
Mailing Address - Street 2:
Mailing Address - City:WHITMORE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48189-9220
Mailing Address - Country:US
Mailing Address - Phone:734-223-3164
Mailing Address - Fax:
Practice Address - Street 1:G3169 BEECHER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3611
Practice Address - Country:US
Practice Address - Phone:810-237-0799
Practice Address - Fax:517-676-5460
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011164361041C0700X
MI6802089147171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical