Individual
JESSICA VANDENBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5060 CASCADE RD SE STE A, GRAND RAPIDS, MI 49546-3808
(616) 954-0950
Mailing address
2051 GRIGGS ST SE, GRAND RAPIDS, MI 49506-4608
(616) 954-0950
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
MI
Other
Enumeration date
12/07/2016
Last updated
12/07/2016
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