Provider Demographics
NPI:1033542063
Name:VANELSLANDER, KEN ALAN (MA, SST)
Entity type:Individual
Prefix:MR
First Name:KEN
Middle Name:ALAN
Last Name:VANELSLANDER
Suffix:
Gender:M
Credentials:MA, SST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 KNOLLS LANDING DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1888
Mailing Address - Country:US
Mailing Address - Phone:313-212-7586
Mailing Address - Fax:
Practice Address - Street 1:120 S MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1975
Practice Address - Country:US
Practice Address - Phone:248-390-5791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1960471101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health