Provider Demographics
NPI:1679622633
Name:VANHOUTTEGHEM, PADGETT DEE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:PADGETT
Middle Name:DEE
Last Name:VANHOUTTEGHEM
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 1:1163 N VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-8076
Mailing Address - Country:US
Mailing Address - Phone:989-551-3200
Mailing Address - Fax:989-551-3200
Practice Address - Street 1:1163 N VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-8076
Practice Address - Country:US
Practice Address - Phone:989-551-3200
Practice Address - Fax:989-551-3200
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801071470104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
0M31710Medicare ID - Type Unspecified