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General NPI Number Information
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NPI Number | 1336586643
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Entity Type | Individual
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Provider Name | ROGER ALLEN DEKUIPER LLP & LMSW
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Gender | Male
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Dates
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Enumeration Date | 05/28/2013
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Last Update Date | 05/28/2013
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Provider Practice Location Address
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Address Line | 4761 66TH ST
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City | HOLLAND
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State | MI
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Zip | 49423-8932
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Country | US
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Telephone | 616-335-3065
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Fax |
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Provider Business Mailing Address
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Address Line | 4761 66TH ST
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City | HOLLAND
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State | MI
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Zip | 49423-8932
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Country | US
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Telephone | 616-335-3065
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301002646
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License Number State | MI
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