Healthcare Provider Details

I. General information

NPI: 1356258255
Provider Name (Legal Business Name): LISA VANORDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 E BELTLINE AVE NE STE C
GRAND RAPIDS MI
49525-9802
US

IV. Provider business mailing address

11943 PULVER RD
LAINGSBURG MI
48848-9311
US

V. Phone/Fax

Practice location:
  • Phone: 989-294-2366
  • Fax:
Mailing address:
  • Phone: 989-294-2366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: