Provider Demographics
NPI:1518383660
Name:HONDORP, SHAWN (PHD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:HONDORP
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SHAWN
Other - Middle Name:
Other - Last Name:KATTERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4100 LAKE DR SE
Practice Address - Street 2:SUITE B01
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8293
Practice Address - Country:US
Practice Address - Phone:616-267-7400
Practice Address - Fax:616-267-7444
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015793103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical