Healthcare Provider Details

I. General information

NPI: 1821542218
Provider Name (Legal Business Name): DONNA KAY VANDER KODDE MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS DONNA KAY KNOPER

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5242 PLAINFIELD AVE NE SUITE C
GRAND RAPIDS MI
49525
US

IV. Provider business mailing address

5242 PLAINFIELD AVE NE SUITE C
GRAND RAPIDS MI
49525
US

V. Phone/Fax

Practice location:
  • Phone: 616-236-3281
  • Fax: 616-734-6205
Mailing address:
  • Phone: 616-236-3281
  • Fax: 616-734-6205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: