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Individual

JERRY BERNARD VANLEEUWEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PHD

Contact information

Practice address
6255 28TH ST SE STE M, GRAND RAPIDS, MI 49546-6966
(616) 458-5294
(616) 458-5295
Mailing address
6255 28TH ST SE STE M, GRAND RAPIDS, MI 49546-6966
(616) 458-5294
(616) 458-5295

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301003978
MI
103TC1900X
Counseling Psychologist
103TF0000X
Family Psychologist
4101000398
MI

Other

Enumeration date
05/30/2007
Last updated
01/31/2024
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