Healthcare Provider Details

I. General information

NPI: 1316855463
Provider Name (Legal Business Name): AUSTIN VASQUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9758 KRAFT AVE SE
CALEDONIA MI
49316-7376
US

IV. Provider business mailing address

9758 KRAFT AVE SE
CALEDONIA MI
49316-7376
US

V. Phone/Fax

Practice location:
  • Phone: 616-891-1380
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number26149080546
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: