Healthcare Provider Details

I. General information

NPI: 1477157824
Provider Name (Legal Business Name): SAMANTHA VANDUSER BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4870 W CLARK RD STE 1
YPSILANTI MI
48197-1104
US

IV. Provider business mailing address

4870 W CLARK RD STE 1
YPSILANTI MI
48197-1104
US

V. Phone/Fax

Practice location:
  • Phone: 734-361-2504
  • Fax:
Mailing address:
  • Phone: 734-361-2504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401003125
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: