Provider Demographics
NPI:1871350595
Name:VANDERMEER, JANE (MAT, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:VANDERMEER
Suffix:
Gender:F
Credentials:MAT, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 HEATHER DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4498
Mailing Address - Country:US
Mailing Address - Phone:616-834-6962
Mailing Address - Fax:
Practice Address - Street 1:1344 HEATHER DR
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-4498
Practice Address - Country:US
Practice Address - Phone:616-834-6962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101005236235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist