Provider Demographics
NPI:1942271614
Name:VAN DOORNE, KAREN (AUD)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:VAN DOORNE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-9602
Mailing Address - Country:US
Mailing Address - Phone:616-796-9387
Mailing Address - Fax:616-796-9388
Practice Address - Street 1:391 GARDEN AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-9602
Practice Address - Country:US
Practice Address - Phone:616-796-9387
Practice Address - Fax:616-796-9388
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000082231H00000X, 231HA2400X, 231HA2500X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4145294Medicaid
MI4145294Medicaid