Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 6301012811 | MI |
Y | 103T00000X | Psychologist | 6301012811 | MI |
NPI | 1013954981 |
---|---|
Provider Name | Mrs. Jennifer L Vandenheuvel |
First Address | Norton Shores, MI 49441-4413 |
Second Address | Norton Shores, MI 49441-4705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 15/07/2014 |