MEDICARE: DR. JENNIFER ELIZABETH VANDERTUUK-PERKINS PHD

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
1	101YM0800X	Mental Health Counselor	PC005978	PA
2	101YM0800X	Mental Health Counselor	6401007979	MI

General Provider Information

NPI Number	:	1629228275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER ELIZABETH VANDERTUUK-PERKINS PHD

Provider Business Mailing Address
First Line	:	1840 MAPLE AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-6017
Country	:	US
Telephone Number	:	616-450-4197
Fax Number	:

Provider Business Practice Location Address
First Line	:	1840 MAPLE AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-6017
Country	:	US
Telephone Number	:	616-450-4197
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2008
Last Update Date	:	04/13/2026

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