Provider Demographics
NPI:1447982541
Name:VANDYKE, TRISHA MARIE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:MARIE
Last Name:VANDYKE
Suffix:
Gender:
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:MARIE
Other - Last Name:BALDWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:376 E APPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-3466
Mailing Address - Country:US
Mailing Address - Phone:231-724-1111
Mailing Address - Fax:
Practice Address - Street 1:2450 44TH ST SE STE 201
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49512-9081
Practice Address - Country:US
Practice Address - Phone:616-528-0870
Practice Address - Fax:616-591-5684
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101007889235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist