Provider Demographics
NPI:1184078339
Name:VANDENHOEK, REBECCA J (LLMSW)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:J
Last Name:VANDENHOEK
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 KENMOOR AVE SE STE A
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2390
Mailing Address - Country:US
Mailing Address - Phone:616-200-6688
Mailing Address - Fax:616-200-6689
Practice Address - Street 1:833 KENMOOR AVE SE STE A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2390
Practice Address - Country:US
Practice Address - Phone:616-200-6688
Practice Address - Fax:616-200-6689
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801095906104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker