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AUDREY JOY-BAKER VANDER WAL MA, LPC
NPI 1396351995
Counselor - Professional in Grand Rapids, MI

Active since September 18, 2020PECOS Enrolled
2305 E PARIS AVE SE STE 203, GRAND RAPIDS, MI 49546(616) 816-1758(616) 333-7685 Get Directions Write a Review

NPPES record last updated: April 26, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Apr 26, 2024, Sep 18, 2020 (2 updates tracked since 2020).

About Audrey Joy-baker Vander Wal Ma, Lpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AUDREY JOY-BAKER VANDER WAL MA, LPC (NPI 1396351995) is an individual professional provider in Grand Rapids, Michigan, licensed in Michigan (6401223152) and active in the NPI registry since September 2020. She is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of Other (2020).

NPPES Registry Identity

NPI1396351995
Entity TypeIndividualFemale
Primary Taxonomy101YP2500X
Provider Legal NameAUDREY JOY-BAKER VANDER WALCredential: MA, LPC
Location Address2305 E PARIS AVE SE STE 203Grand Rapids, MI 49546-2426
Mailing Address184 Glendale StHolland, MI 49423-3031 · (719) 310-4557
Phone(616) 816-1758
Fax(616) 333-7685
Sole ProprietorNo
Medical School CMSOtherGraduated 2020
Enumeration DateSeptember 18, 2020
Last NPPES UpdateApril 26, 20242 updates tracked since enumeration
NPPES CertifiedApril 26, 2024
✔ NPI 1396351995 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in MI · 6401223152
2305 E PARIS AVE SE STE 203, Grand Rapids, MI 49546
Open in Google Maps ↗

Secondary Practice Locations 2

Location 1648 Monroe Ave NW Ste 100Grand Rapids, MI 49503-6714 · Phone (616) 916-3711
Location 24175 Parkway Place Dr SW Ste 100Grandville, MI 49418-2382 · Phone (616) 371-5166 · Fax (616) 333-7685

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company, Priority Health.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Audrey Joy-baker Vander Wal Ma, Lpc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID6002256443
PECOS Enrollment IDI20240501003978
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Audrey Vander Wal reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Stange Clinic, PC
Same address
Clinical
2305 E PARIS AVE SE STE 203
Grand Rapids, MI 49546
  • Reassigned Medicare billing, Michigan enrollment
  • 9 clinicians in this Medicare group
NPI 1205564531 (616) 816-1758

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BRYAN ROSS CREEGER
Counselor (Mental Health)
2305 E PARIS AVE SE STE 203
GRAND RAPIDS, MI 49546
Kent County (616) 929-0226
MS. JENNIFER LYNN BEDFORD LLP
Psychologist
2305 E PARIS AVE SE STE 203
GRAND RAPIDS, MI 49546
Kent County (616) 951-1132
MRS. SHASTA LANE GROSS MA, LPC
Counselor (Professional)
2305 E PARIS AVE SE STE 203
GRAND RAPIDS, MI 49546
Kent County (616) 816-1758
STANGE CLINIC, PC
Psychologist (Clinical)
2305 E PARIS AVE SE STE 203
GRAND RAPIDS, MI 49546
Kent County (616) 816-1758
ERIN MCKAY
Counselor (Mental Health)
2305 E PARIS AVE SE STE 203
GRAND RAPIDS, MI 49546
Kent County (616) 481-3784
MR. JOSEPH PAUL MARTINO LLPC
Counselor (Mental Health)
2305 E PARIS AVE SE STE 203
GRAND RAPIDS, MI 49546
Kent County (616) 929-0226
JASON DAVID LOWELL LPC
Counselor (Mental Health)
2305 E PARIS AVE SE STE 203
GRAND RAPIDS, MI 49546
Kent County (616) 816-1758
SYDNEY RAMEY LLMSW
Social Worker
2305 E PARIS AVE SE STE 203
GRAND RAPIDS, MI 49546
Kent County (616) 816-1758

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Audrey Vander Wal's NPI number?

The NPI number for Audrey Vander Wal is 1396351995. It was assigned to this individual provider in the NPPES registry on September 18, 2020.

Where is Audrey Vander Wal located?

Audrey Vander Wal practices at 2305 E Paris Ave SE Ste 203, Grand Rapids, MI 49546. The listed phone number is (616) 816-1758.

What is Audrey Vander Wal's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is Audrey Vander Wal enrolled in Medicare?

Yes. Audrey Vander Wal is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Audrey Vander Wal's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Audrey Vander Wal reassigns Medicare benefits to Stange Clinic, PC (Grand Rapids, MI). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Audrey Vander Wal's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Audrey Vander Wal accept?

Health plans from Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company and Priority Health list Audrey Vander Wal as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Audrey Vander Wal was last updated on April 26, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.