Provider Demographics
NPI:1477253474
Name:VANECK, MORGAN RENEE
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:RENEE
Last Name:VANECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:
Other - Last Name:WALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12109 NORTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49319-8455
Mailing Address - Country:US
Mailing Address - Phone:810-347-1868
Mailing Address - Fax:
Practice Address - Street 1:2787 WILSON AVE NW
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MI
Practice Address - Zip Code:49534-7510
Practice Address - Country:US
Practice Address - Phone:616-915-2066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician