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General NPI Number Information
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NPI Number | 1548106511
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Entity Type | Organization
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Legal Business Name | JAMIE VANDER VELDEN LLC
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Dates
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Enumeration Date | 04/23/2026
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Last Update Date | 04/23/2026
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Provider Practice Location Address
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Address Line | 23642 STATE ROAD 35 LOT 28
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City | SIREN
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State | WI
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Zip | 54872-8226
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Country | US
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Telephone | 715-566-1699
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Fax |
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Provider Business Mailing Address
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Address Line | 23642 STATE ROAD 35 LOT 28
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City | SIREN
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State | WI
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Zip | 54872-8226
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Country | US
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Telephone | 715-566-1699
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | JAMIE A VANDER VELDEN
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Credential | MSW, LICSW, LCSW
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Telephone | 715-566-1699
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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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