Provider Demographics
NPI:1992169148
Name:VAN ASTEN AND ASSOCIATES LLC
Entity type:Organization
Organization Name:VAN ASTEN AND ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOLYNN
Authorized Official - Middle Name:M
Authorized Official - Last Name:VAN ASTEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:920-495-7033
Mailing Address - Street 1:132 S 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-2242
Mailing Address - Country:US
Mailing Address - Phone:920-333-1514
Mailing Address - Fax:
Practice Address - Street 1:132 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-2242
Practice Address - Country:US
Practice Address - Phone:920-333-1514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health