Provider Demographics
NPI:1710552831
Name:VANDERGELD, LINDSAY M
Entity Type:Individual
Prefix:MS
First Name:LINDSAY
Middle Name:M
Last Name:VANDERGELD
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 1:11778 WAVERLY SHRS
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-9304
Mailing Address - Country:US
Mailing Address - Phone:616-283-6953
Mailing Address - Fax:
Practice Address - Street 1:5281 CLYDE PARK AVE SW STE 2
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-9506
Practice Address - Country:US
Practice Address - Phone:616-719-4263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician