Provider Demographics
NPI:1386287704
Name:ALDRED, DESTINY REBECCA
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:REBECCA
Last Name:ALDRED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DESTINY
Other - Middle Name:
Other - Last Name:VREDENBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:490 N PERRY ST
Mailing Address - Street 2:
Mailing Address - City:BARRYTON
Mailing Address - State:MI
Mailing Address - Zip Code:49305-9710
Mailing Address - Country:US
Mailing Address - Phone:231-250-6533
Mailing Address - Fax:
Practice Address - Street 1:4473 220TH AVE
Practice Address - Street 2:
Practice Address - City:REED CITY
Practice Address - State:MI
Practice Address - Zip Code:49677-8593
Practice Address - Country:US
Practice Address - Phone:231-832-2247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511110501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical