Provider Demographics
NPI:1013954981
Name:VANDENHEUVEL, JENNIFER L (LLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:VANDENHEUVEL
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:BORUSHKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLP
Mailing Address - Street 1:2291 BLISSFIELD CT
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-4413
Mailing Address - Country:US
Mailing Address - Phone:231-740-8182
Mailing Address - Fax:231-739-8805
Practice Address - Street 1:3611 HENRY ST
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-4705
Practice Address - Country:US
Practice Address - Phone:231-740-8182
Practice Address - Fax:231-739-8805
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012811103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist