Basic Information
| Provider Information | |||||||||
| NPI: | 1801368337 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VELDHEER | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | LOUISE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LLMSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SZOKOWSKI | ||||||||
| OtherFirstName: | SARA | ||||||||
| OtherMiddleName: | LOUISE | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2100 RAYBROOK ST SE STE 300 | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495465783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162355100 | ||||||||
| FaxNumber: | 6162355050 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 RAYBROOK ST SE STE 300 | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495465783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162355100 | ||||||||
| FaxNumber: | 6162355050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2018 | ||||||||
| LastUpdateDate: | 12/21/2018 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801094459 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.