Organization
JERRY B VANLEEUWEN PHD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY B. VAN LEEUWEN PHD (PRESIDENT)
(616) 458-5294
Entity
Organization
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
103TB0200X
Cognitive & Behavioral Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336340140
—
MI
Enumeration date
10/09/2007
Last updated
12/04/2023
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