Provider Demographics
NPI:1588355390
Name:VANDOORNE, ALLISON MARIE (LLMSW)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARIE
Last Name:VANDOORNE
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-0609
Mailing Address - Country:US
Mailing Address - Phone:616-500-0323
Mailing Address - Fax:616-259-4214
Practice Address - Street 1:1959 THORNAPPLE RIVER DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-9706
Practice Address - Country:US
Practice Address - Phone:616-327-2405
Practice Address - Fax:616-259-4214
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511165131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical