Provider Demographics
NPI:1639235989
Name:VERMERRIS, DANE (EDD)
Entity Type:Individual
Prefix:DR
First Name:DANE
Middle Name:
Last Name:VERMERRIS
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 SINCLAIR AVE NE
Mailing Address - Street 2:STE D
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-4156
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4670 FULTON ST E
Practice Address - Street 2:STE D
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-8455
Practice Address - Country:US
Practice Address - Phone:616-644-0022
Practice Address - Fax:616-940-8151
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005868103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical