Provider Demographics
NPI:1609548908
Name:VANHEKKEN, KATHLYNN J
Entity Type:Individual
Prefix:
First Name:KATHLYNN
Middle Name:J
Last Name:VANHEKKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 GLEN ECHO DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5524
Mailing Address - Country:US
Mailing Address - Phone:616-308-7591
Mailing Address - Fax:
Practice Address - Street 1:2425 GLEN ECHO DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5524
Practice Address - Country:US
Practice Address - Phone:616-308-7591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor