Jerry B Vanleeuwen PHD PC

Primary specialty

Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X

Legal business name

JERRY B VANLEEUWEN PHD PC

Practice address

6255 28TH St SE Ste M
Grand Rapids, MI 49546-6966

Phone

(616) 458-5294

Fax

(616) 458-5295

NPI assigned

Oct 9, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Jerry B. Van Leeuwen, PHDNPI 1336340140

Title

President

Phone

(616) 458-5294

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jerry Bernard Vanleeuwen, PHD

  • Psychologist
  • Grand Rapids, MI
  • NPI 1336340140
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701648000000",
    "number": "1497943146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6255 28TH ST SE STE M",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495466966",
            "telephone_number": "616-458-5294",
            "fax_number": "616-458-5295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6255 28TH ST SE STE M",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495466966",
            "telephone_number": "616-458-5294",
            "fax_number": "616-458-5295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY B VANLEEUWEN PHD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-09",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A",
        "authorized_official_last_name": "VAN LEEUWEN",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "616-458-5294",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1336340140",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heather Jereb, M.D.
• Lyric Jerelos
• Jacqueline Mackenzie Jernigan
• Grace Elizabeth Jerome, LLMSW
• Carrie J Jerow, MPAS, PA-C
• Jerry B. Mulder DDS PLC
• Jerry Burgess Mulder
• Jerry'S Dream Adult Homes
• Todd Palmer Jervis, RPH
• Mark Jesin, DDS

• Cognitive & Behavioral Psychologist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Cognitive & Behavioral Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.