Provider Demographics
NPI:1902961766
Name:VANDERWALKER, MICHAEL PAUL (LMSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PAUL
Last Name:VANDERWALKER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 MOHAWK STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-5349
Mailing Address - Country:US
Mailing Address - Phone:517-782-6674
Mailing Address - Fax:517-782-6742
Practice Address - Street 1:153 MOHAWK STREET
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-5349
Practice Address - Country:US
Practice Address - Phone:517-782-6674
Practice Address - Fax:517-782-6742
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010469011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical