Provider Demographics
NPI:1831877521
Name:VANDER PLOEG, NOLAN
Entity type:Individual
Prefix:
First Name:NOLAN
Middle Name:
Last Name:VANDER PLOEG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2584 HIGH POINT RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:54521-9733
Mailing Address - Country:US
Mailing Address - Phone:763-760-4203
Mailing Address - Fax:
Practice Address - Street 1:22 N PELHAM ST
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3148
Practice Address - Country:US
Practice Address - Phone:171-536-5669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7495226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health