| Stacey Vanderklok, Llc | |
|
600 3 Mile Rd Nw Ste 101 Grand Rapids MI 49544-1691 | |
| (616) 207-3292 | |
| Not Available |
| Full Name | Stacey Vanderklok, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 600 3 Mile Rd Nw Ste 101, Grand Rapids, Michigan |
| Authorized Official Name and Position | Stacey Vanderklok (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 6163503968 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stacey Vanderklok, Llc 600 3 Mile Rd Nw Ste 101 Grand Rapids MI 49544-1691 Ph: () - | Stacey Vanderklok, Llc 600 3 Mile Rd Nw Ste 101 Grand Rapids MI 49544-1691 Ph: (616) 207-3292 |
| NPI Number | 1629784400 |
|---|---|
| Provider Enumeration Date | 01/25/2023 |
| Last Update Date | 01/25/2023 |
| Certification Date | 01/25/2023 |
| Medicare PECOS PAC ID | 2466807185 |
|---|---|
| Medicare Enrollment ID | O20231016000996 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629784400 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Stacey M Vanderklok |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578653986 PECOS PAC ID: 7012916513 Enrollment ID: I20061211000456 |
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