Provider Demographics
NPI:1609928167
Name:VANDEN BERG, HEIDI RENEE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:RENEE
Last Name:VANDEN BERG
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 1:10560 W HERBISON RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:MI
Mailing Address - Zip Code:48822-9503
Mailing Address - Country:US
Mailing Address - Phone:517-626-2635
Mailing Address - Fax:
Practice Address - Street 1:701 S CREYTS RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8234
Practice Address - Country:US
Practice Address - Phone:517-323-4099
Practice Address - Fax:517-323-3334
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010649101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical