Provider Demographics
NPI:1154137057
Name:VANDENBOSCH, STEPHANIE ANN (LLC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:VANDENBOSCH
Suffix:
Gender:F
Credentials:LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 JERICHO RD
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-5153
Mailing Address - Country:US
Mailing Address - Phone:269-425-5331
Mailing Address - Fax:
Practice Address - Street 1:652 CAPITAL AVE NE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-5535
Practice Address - Country:US
Practice Address - Phone:269-425-5331
Practice Address - Fax:269-224-6559
Is Sole Proprietor?:No
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451024043101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health