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Individual
PETER H VANDYKEN
Active
Individual
PETER H VANDYKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6801079750
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
80D162220
BC/BS
MI
Enumeration date
09/29/2006
Last updated
07/09/2007
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