JERRY B. VAN LEEUWEN PHD, PC
Social Work at Monroe Center St, Grand Rapids, MI

License number
Michigan 6301003978
Category
Social Work
Type
Clinical
Owner
Name: DR. JERRY B. VAN LEEUWEN PHD
Title: PRESIDENT
Phone: (616) 458-5294
Address
Address
20 Monroe Center St NE SUITE 201, Grand Rapids, MI 49503
National Provider ID: 1497943146
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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JERRY B. VAN LEEUWEN, PH.D., PC

300 Trade Ctr, Grand Rapids, MI 49503

Status:
Inactive
Registration:
Aug 7, 1991
State ID:
195178
Business type:
Domestic Professional Service Corporation
Expiration:
7-15-1995
Agent:
Jerry B. Van Leeuwen

JERRY B. VAN LEEUWEN, PH.D., PC

Grand Rapids, MI

Status:
Inactive
Registration:
Dec 8, 2003
Addresses:
698 Highbury Ct SE, Grand Rapids, MI 49546 (Physical)
Michigan (Mailing)
State ID:
08800D
Business type:
Domestic Professional Service Corporation
Expiration:
7-15-2010
Agent:
Jerry B Van Leeuwen

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