1629356175 NPI number — MRS. RIA ANASTASIA NIEBOER LMSW, CAADC, ADS

Table of content: MRS. RIA ANASTASIA NIEBOER LMSW, CAADC, ADS (NPI 1629356175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629356175 NPI number — MRS. RIA ANASTASIA NIEBOER LMSW, CAADC, ADS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIEBOER
Provider First Name:
RIA
Provider Middle Name:
ANASTASIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW, CAADC, ADS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NIEBOER
Provider Other First Name:
RIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629356175
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
926 WASHINGTON AVE
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
HOLLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49423-7725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-820-3780
Provider Business Mailing Address Fax Number:
616-820-3785

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
926 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
HOLLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49423-7725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-820-3780
Provider Business Practice Location Address Fax Number:
616-820-3785
Provider Enumeration Date:
08/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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