| Doctor Name: | ROSANNA VAN WYCK |
| NPI Number: | 1013281450 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LLPC |
| License Number: | 6401012777 |
| Business Practice Address: | 920 Diana St Ludington, MI - 494311987 |
| Business Phone Number: | 2318456294 |
| Business Fax Number: | 2318457095 |
| Mailing Address: | 920 Diana St, LUDINGTON |
| State: | MI |
| Postal Code: | 494311987 |
| Phone Number: | 2318456294 |
| Fax Number: | 2318457095 |
| NPI Enumeration Date: | 03/02/2012 |
| NPI Last Update Date: | 09/17/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 6401012777 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |