Provider Demographics
NPI:1386174662
Name:VANDEVUSSE, ALLISON M (LMSW)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:M
Last Name:VANDEVUSSE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:M
Other - Last Name:SEIB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:336 S RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3326
Practice Address - Country:US
Practice Address - Phone:616-394-3788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801097542104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker