Provider Demographics
NPI:1427254275
Name:VANDENBRINK, SANDRA KAY (LMSW)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:KAY
Last Name:VANDENBRINK
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 1:3933 KERRI CT
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-9492
Mailing Address - Country:US
Mailing Address - Phone:616-738-9030
Mailing Address - Fax:
Practice Address - Street 1:1465 3 MILE RD NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-1614
Practice Address - Country:US
Practice Address - Phone:616-784-5095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801017554101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM71750Medicare ID - Type UnspecifiedMEDICARE