Provider Demographics
NPI:1699187138
Name:VLIETSTRA, ERIN (MSW)
Entity Type:Individual
Prefix:MISS
First Name:ERIN
Middle Name:
Last Name:VLIETSTRA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:ANSTEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 E MILHAM AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-1492
Mailing Address - Country:US
Mailing Address - Phone:269-249-7179
Mailing Address - Fax:
Practice Address - Street 1:800 E MILHAM AVE STE 200
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-1492
Practice Address - Country:US
Practice Address - Phone:269-249-7179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010959551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical