Provider Demographics
NPI:1417778267
Name:VAN HOUDT, ERICA ELIZABETH
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:ELIZABETH
Last Name:VAN HOUDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16075 MEDDLER AVE NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49319-8709
Mailing Address - Country:US
Mailing Address - Phone:616-745-3181
Mailing Address - Fax:
Practice Address - Street 1:16075 MEDDLER AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49319-8709
Practice Address - Country:US
Practice Address - Phone:616-745-3181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI82547225800000X, 226000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreational Therapist Assistant
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist