Provider Demographics
NPI:1700297538
Name:STEKETEE, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:STEKETEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 BALDWIN ST
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-8909
Mailing Address - Country:US
Mailing Address - Phone:616-204-5663
Mailing Address - Fax:
Practice Address - Street 1:17615 BAILEY RD
Practice Address - Street 2:
Practice Address - City:BAILEY
Practice Address - State:MI
Practice Address - Zip Code:49303-9729
Practice Address - Country:US
Practice Address - Phone:616-204-5663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011165103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist