Provider Demographics
NPI:1740246339
Name:DONDERS, JACOBUS AM (PHD)
Entity type:Individual
Prefix:DR
First Name:JACOBUS
Middle Name:AM
Last Name:DONDERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 WEALTHY SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503
Mailing Address - Country:US
Mailing Address - Phone:616-242-9201
Mailing Address - Fax:616-451-9513
Practice Address - Street 1:235 WEALTHY SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503
Practice Address - Country:US
Practice Address - Phone:616-242-9201
Practice Address - Fax:616-451-9513
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007509103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
JD007509OtherPRIORITY HEALTH BLUE CROS