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General NPI Number Information
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NPI Number | 1538664826
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Entity Type | Individual
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Provider Name | MAICEE ANNE VANSKYOCK
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Gender | Female
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Dates
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Enumeration Date | 03/28/2018
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Last Update Date | 06/12/2024
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Provider Practice Location Address
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Address Line | 550 CASCADE WEST PKWY SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2137
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Country | US
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Telephone | 616-930-4123
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Fax | 616-323-3994
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Provider Business Mailing Address
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Address Line | 427 W BENSON ST
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City | HASTINGS
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State | MI
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Zip | 49058-1174
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Country | US
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Telephone | 269-425-8490
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6851116012
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License Number State | MI
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