Provider Demographics
NPI:1447526272
Name:JANDERNOA, DANIELLE KATHRYNE (LMSW)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:KATHRYNE
Last Name:JANDERNOA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 3 MILE RD NW
Mailing Address - Street 2:STE 2
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544-8216
Mailing Address - Country:US
Mailing Address - Phone:616-202-2342
Mailing Address - Fax:616-369-3769
Practice Address - Street 1:890 3 MILE RD NW
Practice Address - Street 2:STE 2
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-8216
Practice Address - Country:US
Practice Address - Phone:616-202-2342
Practice Address - Fax:616-369-3769
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010938151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical