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NPI Code Detail

MEDICARE: MRS. JENNIFER L VANDENHEUVEL LLP

MEDICARE: MRS. JENNIFER L VANDENHEUVEL LLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist6301012811MI

General Provider Information

NPI Number : 1013954981
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER L VANDENHEUVEL LLP
Provider Business Mailing Address
First Line : 2291 BLISSFIELD CT
Second Line :
City : NORTON SHORES
State : MI
Zip : 49441-4413
Country : US
Telephone Number : 231-740-8182
Fax Number : 231-739-8805
Provider Business Practice Location Address
First Line : 3611 HENRY ST
Second Line :
City : NORTON SHORES
State : MI
Zip : 49441-4705
Country : US
Telephone Number : 231-740-8182
Fax Number : 231-739-8805
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2006
Last Update Date : 07/15/2014

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