Doctor Name: | DIANA MARIE VAN DE KREEKE |
NPI Number: | 1134500234 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHD |
License Number: | 6301015562 |
Business Practice Address: | 2750 E Beltline Ave Ne Grand Rapids, MI - 495258614 |
Business Phone Number: | 6162677104 |
Business Fax Number: | 6162677594 |
Mailing Address: | 100 Michigan St Ne # Mc845, GRAND RAPIDS |
State: | MI |
Postal Code: | 495032560 |
Phone Number: | 6164856790 |
Fax Number: | 6164866702 |
NPI Enumeration Date: | 06/15/2015 |
NPI Last Update Date: | 06/15/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | 6301015562 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |