Provider Demographics
NPI:1215110887
Name:VANDENBOSCH, JULIA LYNN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:LYNN
Last Name:VANDENBOSCH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8951 BOSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-9464
Mailing Address - Country:US
Mailing Address - Phone:616-831-5582
Mailing Address - Fax:616-942-0589
Practice Address - Street 1:3300 36TH ST SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49512-2810
Practice Address - Country:US
Practice Address - Phone:616-831-5582
Practice Address - Fax:616-942-0589
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010649221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical