Provider Demographics
NPI:1952473928
Name:VANDER BENT, JILL SUZANN (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:SUZANN
Last Name:VANDER BENT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 S RIVER AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-2848
Mailing Address - Country:US
Mailing Address - Phone:616-260-0993
Mailing Address - Fax:
Practice Address - Street 1:186 S RIVER AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-2848
Practice Address - Country:US
Practice Address - Phone:616-260-0993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801085501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical