MRS. STACEY MICHELLE VANDERKOLK (NPI# 1326291170) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1326291170 |
Entity Type | Individual |
Full Name | MRS. STACEY MICHELLE VANDERKOLK |
Other Name | MISS STACEY MICHELLE BENNETT |
Credential | BA CADC |
Practice Address |
54 S Jackson St Janesville WI 53548-3837 |
Mailing Address |
1601 University Drive Rockford IL 61107 |
Practice Telephone | 6087528716 |
Mailing Telephone | 8153911000 |
Mailing Fax Number | 8153915040 |
Enumeration Date | 2008-10-24 |
Last Update Date | 2009-07-22 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
22263 | IL | Behavioral Health & Social Service Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
IL | 42254500 | 05 |
Street Address |
54 S JACKSON ST |
City | JANESVILLE |
State | WI |
Zip Code | 53548-3837 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1245480060 | Rosecrance, Inc. | Substance Abuse Rehabilitation Facility | 54 S Jackson St, Janesville, WI 53548-3837 | 2008-09-29 |
1013535012 | Hannah E Leclair | Social Worker | 54 S Jackson St, Janesville, WI 53548-3837 | 2020-07-07 |
1215554597 | Rhiannon Marie Decker | Social Worker | 54 S Jackson St, Janesville, WI 53548-3837 | 2020-07-02 |
1417574971 | Elizabeth White | Social Worker | 54 S Jackson St, Janesville, WI 53548-3837 | 2020-07-01 |
1083231559 | Isabelle Zahn | Social Worker | 54 S Jackson St, Janesville, WI 53548-3837 | 2020-07-01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1578846010 | Patricia Ann Sheets | Licensed Vocational Nurse | 316 N. Terrace St., Janbesville, WI 53548 | 2011-09-21 |
1760658983 | Kristy Kay Prentice Kerl | Dental Hygienist | 121 Jonathon Dr, Janesville, WI 53548 | 2008-05-07 |
1316005978 | City of Janesville | Emergency Medical Technician, Paramedic | 18 N Jackson St, Janesville, WI 53548 | 2006-12-05 |
1558464115 | Sarah Louise Hessenauer | Social Worker | 17 S. River St, Suite 254, Janesville, WI 53548 | 2006-09-07 |
1073548327 | Mary Katherine Cefalu | Registered Nurse | 17 S. River, Suite 254, Janesville, WI 53548 | 2006-07-12 |
1699707950 | Gary Lavern Jones | Counselor | 175 River, Suite 254, Janesville, WI 53548 | 2006-07-07 |
1295767424 | Michael Stuart Kaye | Clinical Neuropsychologist | 17 S River St Ste 254, Janesville, WI 53548 | 2006-07-07 |
1205864055 | Amy Laurie Roy | Counselor | 17 S River Suite 254, Janesville, WI 53548 | 2006-06-29 |
1518903566 | Leota I Larson | Psychologist | 17 S River, Suite 254, Janesville, WI 53548 | 2006-06-20 |
1760950414 | North Star Chiropractic LLC | Chiropractor | 21 S Jackson St, Ste 160, Janesville, WI 53548 | 2018-11-10 |
Find all providers in zip 53548 |
Taxonomy Code | 101YA0400X |
Grouping | Behavioral Health & Social Service Providers |
Classification | Counselor |
Specialization | Addiction (Substance Use Disorder) |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1700131232 | Tiffany L Strodthoff | Counselor | 15 W Milwaukee St Ste 207, Janesville, WI 53548-2998 | 2012-07-20 |
1396018131 | Holli K Tinder | Counselor | 2000 E Racine St Ste 120, Janesville, WI 53545-4300 | 2012-02-09 |
1821398736 | Passageway, Inc. Frs-tr | Counselor | 3246 W Rollingwood Dr, Janesville, WI 53545-9030 | 2010-10-25 |
1154631679 | Cheryl M Frei | Counselor | 200 S Parker Dr, Janesville, WI 53545-3932 | 2010-10-18 |
1851546667 | Amanda L Ballard | Counselor | 2600 Humes Rd Ste 100, Janesville, WI 53545 | 2008-11-20 |
1376711671 | Kim N Conrad | Counselor | 612 N Randall Ave Ste A, Janesville, WI 53545-1958 | 2008-02-20 |
1093992158 | Emma Gene Harrell | Counselor | 203 W Sunny Lane, Janesville, WI 53546 | 2008-01-30 |
1265562037 | Kathleen M Miller | Counselor | 3246 W. Rollingwood Drive, Janesville, WI 53545-9030 | 2007-03-07 |
1710076914 | William Hollingsworth | Counselor | 2640 Milton Ave, Janesville, WI 53545-0231 | 2006-10-12 |
1255348314 | Sam Paul Romano Jr. | Counselor | 612 N Randall Ave, Janesville, WI 53545-1958 | 2006-08-02 |
Find all providers in JANESVILLE |
City | JANESVILLE |
Zip Code | 53548 |
Please comment or provide details below to improve the information on MRS. STACEY MICHELLE VANDERKOLK.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.