1821542218 NPI number — MRS. DONNA KAY VANDER KODDE MA, LPC

Table of content: MRS. DONNA KAY VANDER KODDE MA, LPC (NPI 1821542218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821542218 NPI number — MRS. DONNA KAY VANDER KODDE MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANDER KODDE
Provider First Name:
DONNA
Provider Middle Name:
KAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KNOPER
Provider Other First Name:
DONNA
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821542218
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5242 PLAINFIELD AVE NE
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-236-3281
Provider Business Mailing Address Fax Number:
616-734-6205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5242 PLAINFIELD AVE NE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-236-3281
Provider Business Practice Location Address Fax Number:
616-734-6205
Provider Enumeration Date:
08/15/2016

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: 101Y00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: VS0079950 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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