Basic Information
| Provider Information | |||||||||
| NPI: | 1760418792 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VER STEEG | ||||||||
| FirstName: | SHANE | ||||||||
| MiddleName: | EVAN | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2611 WASHINGTON STREET | ||||||||
| Address2: | |||||||||
| City: | PELLA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 50219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6416289599 | ||||||||
| FaxNumber: | 6416211493 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 CASCADE WEST PKWY SE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495462137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169304123 | ||||||||
| FaxNumber: | 6163233994 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 08/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801099861 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | 06425 | IA | N | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 1760418792 | 05 | IA | MEDICAID |