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NPI Code Detail

MEDICARE: MATTHEW VANDERHYDE

MEDICARE: MATTHEW VANDERHYDE
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
11041C0700XClinical Social Worker6801091508MI
2104100000XSocial Worker6801091508MI

General Provider Information

NPI Number : 1356550644
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW VANDERHYDE
Provider Business Mailing Address
First Line : 8975 OTTOGAN ST
Second Line :
City : HOLLAND
State : MI
Zip : 49423-9036
Country : US
Telephone Number : 616-443-5471
Fax Number :
Provider Business Practice Location Address
First Line : 5270 NORTHLAND DR NE STE B
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49525-1073
Country : US
Telephone Number : 616-344-4785
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2007
Last Update Date : 10/03/2024

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