Provider Demographics
NPI:1730456435
Name:VANDE WIELE, COURTNEY SKEWES (LMSW)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:SKEWES
Last Name:VANDE WIELE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:SKEWES
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2500 7TH AVE S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-1176
Mailing Address - Country:US
Mailing Address - Phone:906-233-1322
Mailing Address - Fax:906-233-1220
Practice Address - Street 1:2500 7TH AVE S
Practice Address - Street 2:SUITE 100
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1176
Practice Address - Country:US
Practice Address - Phone:906-233-1322
Practice Address - Fax:906-233-1220
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010943881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical