Individual
JACOB SCOTT VANDER KOLK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LLPC
Contact information
Practice address
901 EASTERN AVE NE, GRAND RAPIDS, MI 49503-1201
(616) 224-7617
Mailing address
8714 HONEYBROOK CT, JENISON, MI 49428-9551
(616) 889-0297
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401014202
MI
Other
Enumeration date
06/05/2014
Last updated
06/05/2014
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