Individual
JACOB ALLAN VANDYKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LLBSW
Contact information
Practice address
100 CHERRY ST SE, GRAND RAPIDS, MI 49503-4526
(616) 965-8200
Mailing address
247 SUNSET HILLS AVE NW, WALKER, MI 49534-5845
(616) 550-6784
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6802087325
MI
Other
Enumeration date
06/29/2012
Last updated
06/29/2012
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