Provider Demographics
NPI:1023424199
Name:MICHELLE VANDENHUL, LLC
Entity type:Organization
Organization Name:MICHELLE VANDENHUL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:VANDENHUL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW--PIP
Authorized Official - Phone:605-271-1348
Mailing Address - Street 1:5000 S MINNESOTA AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2707
Mailing Address - Country:US
Mailing Address - Phone:605-271-1348
Mailing Address - Fax:605-610-1477
Practice Address - Street 1:5000 S MINNESOTA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2707
Practice Address - Country:US
Practice Address - Phone:605-271-1348
Practice Address - Fax:605-610-1477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD27401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6571610Medicaid