Provider Demographics
NPI:1619723228
Name:VANORDEN, MIKAYLA DAWN
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:DAWN
Last Name:VANORDEN
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 1:1030 KENT ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ISABELLA
Mailing Address - State:MI
Mailing Address - Zip Code:48893-9363
Mailing Address - Country:US
Mailing Address - Phone:989-506-9022
Mailing Address - Fax:
Practice Address - Street 1:1070 W HOUGHTON LAKE DR
Practice Address - Street 2:
Practice Address - City:PRUDENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48651-9613
Practice Address - Country:US
Practice Address - Phone:988-273-3073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician