Healthcare Provider Details

I. General information

NPI: 1720998644
Provider Name (Legal Business Name): LAURA MICHELLE VANDER BEEK LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 CEDAR ST
PAW PAW MI
49079-1182
US

IV. Provider business mailing address

555 CEDAR ST
PAW PAW MI
49079-1182
US

V. Phone/Fax

Practice location:
  • Phone: 269-674-8091
  • Fax:
Mailing address:
  • Phone: 269-674-8091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851106625
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: