Provider Demographics
NPI:1285167148
Name:DEJONGE, DENISE ELZABETH (LMSW)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:ELZABETH
Last Name:DEJONGE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 KENMOOR AVE SE
Mailing Address - Street 2:SUITE C
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8628
Mailing Address - Country:US
Mailing Address - Phone:616-200-4433
Mailing Address - Fax:
Practice Address - Street 1:781 KENMOOR AVE SE
Practice Address - Street 2:SUITE C
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8628
Practice Address - Country:US
Practice Address - Phone:616-200-4433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010870771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical