Provider Demographics
NPI:1871063636
Name:SIEWERTSZ VAN REESEMA, FREDERIK (LLMSW)
Entity type:Individual
Prefix:
First Name:FREDERIK
Middle Name:
Last Name:SIEWERTSZ VAN REESEMA
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-0602
Mailing Address - Country:US
Mailing Address - Phone:734-707-6209
Mailing Address - Fax:
Practice Address - Street 1:548 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2921
Practice Address - Country:US
Practice Address - Phone:734-707-1052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2019-03-13
Deactivation Date:2018-12-05
Deactivation Code:
Reactivation Date:2019-03-12
Provider Licenses
StateLicense IDTaxonomies
MI6801100271041C0700X
MI68011002781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical