Provider Demographics
NPI:1336586643
Name:DEKUIPER, ROGER ALLEN (LLP & LMSW)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:ALLEN
Last Name:DEKUIPER
Suffix:
Gender:M
Credentials:LLP & LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4761 66TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-8932
Mailing Address - Country:US
Mailing Address - Phone:616-335-3065
Mailing Address - Fax:
Practice Address - Street 1:4761 66TH ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-8932
Practice Address - Country:US
Practice Address - Phone:616-335-3065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002646103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist