Provider Demographics
NPI:1134727753
Name:VANVLEET, MICHAEL ROY (MSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROY
Last Name:VANVLEET
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18754 S LOWRIE LOOP
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8607
Mailing Address - Country:US
Mailing Address - Phone:907-444-5307
Mailing Address - Fax:
Practice Address - Street 1:3001 C ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3913
Practice Address - Country:US
Practice Address - Phone:907-406-4751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical