Individual
MS. REGINA JO VANDERKLOK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BC-HIS
Contact information
Practice address
4598 PLAINFIELD AVE NE, GRAND RAPIDS, MI 49525-1645
(616) 364-0090
(616) 364-7441
Mailing address
4598 PLAINFIELD AVE NE, GRAND RAPIDS, MI 49525-1645
(616) 364-0090
(616) 364-7441
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
3501002836
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4836981
—
MI
01
—
540D10522
BCBS
MI
Enumeration date
01/10/2007
Last updated
02/02/2017
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