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General NPI Number Information
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NPI Number | 1326793894
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Entity Type | Organization
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Legal Business Name | MELISSA JEANNE VANDERZYDEN
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Dates
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Enumeration Date | 02/14/2022
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Last Update Date | 02/14/2022
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Provider Practice Location Address
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Address Line | 826 PARCHMENT DR SE STE 100
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2307
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Country | US
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Telephone | 616-366-4226
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Fax |
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Provider Business Mailing Address
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Address Line | 826 PARCHMENT DR SE STE 100
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2307
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Country | US
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Telephone | 616-366-4226
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA VANDERZYDEN
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Credential | LMSW
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Telephone | 616-460-8547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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