Provider Demographics
NPI:1891914743
Name:VANDERVEEN, JOANNE KATHRINE (MASTERS SOCIAL WORKE)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:KATHRINE
Last Name:VANDERVEEN
Suffix:
Gender:F
Credentials:MASTERS SOCIAL WORKE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4289 LIMOUSIN CT SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49418-8746
Mailing Address - Country:US
Mailing Address - Phone:616-634-8372
Mailing Address - Fax:
Practice Address - Street 1:4289 LIMOUSIN CT SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49418-8746
Practice Address - Country:US
Practice Address - Phone:616-634-8372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010867061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical