| Jerry B Vanleeuwen Phd Pc | |
|
6255 28th St Se Ste M Grand Rapids MI 49546-6966 | |
| (616) 458-5294 | |
| (616) 458-5295 |
| Full Name | Jerry B Vanleeuwen Phd Pc |
|---|---|
| Speciality | Psychologist |
| Location | 6255 28th St Se Ste M, Grand Rapids, Michigan |
| Authorized Official Name and Position | Jerry B. Van Leeuwen (PRESIDENT) |
| Authorized Official Contact | 6164585294 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jerry B Vanleeuwen Phd Pc 6255 28th St Se Ste M Grand Rapids MI 49546-6966 Ph: (616) 458-5294 | Jerry B Vanleeuwen Phd Pc 6255 28th St Se Ste M Grand Rapids MI 49546-6966 Ph: (616) 458-5294 |
| NPI Number | 1497943146 |
|---|---|
| Provider Enumeration Date | 10/09/2007 |
| Last Update Date | 12/04/2023 |
| Certification Date | 12/04/2023 |
| Medicare PECOS PAC ID | 7810084290 |
|---|---|
| Medicare Enrollment ID | O20071101000201 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497943146 | NPI | - | NPPES |
| 1336340140 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TB0200X | Psychologist - Cognitive & Behavioral | (* (Not Available)) | Primary |
| Provider Name | Jerry Vanleeuwen |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1336340140 PECOS PAC ID: 8325135791 Enrollment ID: I20190530001754 |
| Provider Name | Jerry Vanleeuwen |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1336340140 PECOS PAC ID: 8325135791 Enrollment ID: I20240206002778 |
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