Provider Demographics
NPI:1578063095
Name:DEKRYGER, VICTORIA R
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:R
Last Name:DEKRYGER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:VICTORIA
Other - Middle Name:R
Other - Last Name:RUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2814 WOODCLIFF CIR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-3155
Mailing Address - Country:US
Mailing Address - Phone:855-832-6727
Mailing Address - Fax:616-604-8493
Practice Address - Street 1:2814 WOODCLIFF CIR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-3155
Practice Address - Country:US
Practice Address - Phone:248-622-1595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician