Healthcare Provider Details

I. General information

NPI: 1306759493
Provider Name (Legal Business Name): MADALON MARIE VEENSTRA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 W SYCAMORE ST
WAYLAND MI
49348-1338
US

IV. Provider business mailing address

444 VOYAGER DR
WAYLAND MI
49348-9150
US

V. Phone/Fax

Practice location:
  • Phone: 269-792-9208
  • Fax:
Mailing address:
  • Phone: 616-359-2645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6851110811
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: