Healthcare Provider Details

I. General information

NPI: 1962017848
Provider Name (Legal Business Name): KATHERINE MELINDA VANSCHAFFEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE MELINDA VANSCHAFFEL

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5921 BEMISS RD
VALDOSTA GA
31605-7520
US

IV. Provider business mailing address

3363 STALLINGS RD
VALDOSTA GA
31605-4333
US

V. Phone/Fax

Practice location:
  • Phone: 352-478-8179
  • Fax:
Mailing address:
  • Phone: 912-282-3149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: