Nicole Marie Vandussen, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801111269 Issued in MI

Practice address

15575 40TH Ave
Coopersville, MI 49404-9615

Phone

(616) 970-5858

NPI assigned

Oct 11, 2017

Last updated

Dec 15, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1507680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639526400000",
    "number": "1063922433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15575 40TH AVE",
            "city": "COOPERSVILLE",
            "state": "MI",
            "postal_code": "494049615",
            "telephone_number": "616-970-5858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15575 40TH AVE",
            "city": "COOPERSVILLE",
            "state": "MI",
            "postal_code": "494049615",
            "telephone_number": "616-970-5858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDUSSEN",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-11",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801101765",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801111269",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cheryl Ann Thomas, LPN
• Krista Tisdel, LMSW
• Uplift Therapies, LLC
• Casey Vanantwerpen, LPC
• Kara Lynne Vanderboon, OTR/L
• Christina Marie Vanhouten, LMSW
• Melissa Vankampen, PTA
• Dawn K Walt, OD
• Tayler Ward
• Lindsay Watson, LMSW

• Clinical Social Worker in Coopersville, MI
• Providers in Coopersville, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.