Provider Demographics
NPI:1518280262
Name:RIETVELD, NATASHA LEE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:NATASHA
Middle Name:LEE
Last Name:RIETVELD
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 1:12048 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-9661
Mailing Address - Country:US
Mailing Address - Phone:616-396-0623
Mailing Address - Fax:616-396-2315
Practice Address - Street 1:12048 JAMES ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-9661
Practice Address - Country:US
Practice Address - Phone:616-396-0623
Practice Address - Fax:616-396-2315
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1668061104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIL1668061OtherSTATE OF MICHIGAN, DEPARTMENT OF COMMUNITY HEALTH