Healthcare Provider Details

I. General information

NPI: 1538434303
Provider Name (Legal Business Name): MATTHEW D VANDERMEULEN PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 S CARMEL ST
CADILLAC MI
49601-2344
US

IV. Provider business mailing address

5867 NANCY ANN DR
KALAMAZOO MI
49004-9112
US

V. Phone/Fax

Practice location:
  • Phone: 231-775-6517
  • Fax:
Mailing address:
  • Phone: 773-484-0503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301019799
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: