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General NPI Number Information
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NPI Number | 1699335836
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Entity Type | Individual
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Provider Name | REBECCA DE YOUNG
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Gender | Female
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Dates
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Enumeration Date | 06/19/2019
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 483 CENTURY LN
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City | HOLLAND
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State | MI
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Zip | 49423-4286
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Country | US
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Telephone | 616-396-5284
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Fax |
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Provider Business Mailing Address
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Address Line | 483 CENTURY LN
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City | HOLLAND
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State | MI
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Zip | 49423-4286
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Country | US
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Telephone | 616-396-5284
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 99093749A
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License Number State | IN
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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 | 6851117864
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License Number State | MI
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