Michael Jon Vanderwaal, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2021038693 Issued in MO

Practice address

4110 Baltimore Ave
Kansas City, MO 64111-2303

Phone

(816) 200-2320

NPI assigned

Apr 2, 2020

Last updated

Sep 23, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Caring Practitioners Circle

  • Clinical Social Worker
  • Ann Arbor, MI
  • NPI 1093691602
  NPD Authorized official

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

{
    "created_epoch": "1585785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632355200000",
    "number": "1669001665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4049 CENTRAL ST",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641112207",
            "telephone_number": "816-200-2320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4110 BALTIMORE AVE",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641112303",
            "telephone_number": "816-200-2320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERWAAL",
        "first_name": "MICHAEL",
        "middle_name": "JON",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-04-02",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker",
            "state": "MO",
            "license": "2019021597",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2021038693",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caitlin Vandell, MS, CCC-SLP
• Jillon S. Vander Wal
• Hilah Sargent Vanderlippe
• Angela Clements Vanderpool, RN, MSN, CPNP
• Stacey Vanderpool, NP
• Susan K Vandeusen, PLPC
• Andrea M Vandeven, M.D.
• Dustin Kyle Vandolah, MD
• Shauna Michelle Vandoren, DO
• Sydney June Vandyke

• Clinical Social Worker in Kansas City, MO
• Providers in Kansas City, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 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.