Healthcare Provider Details

I. General information

NPI: 1104332980
Provider Name (Legal Business Name): KRISTINA MARIE VANDERHOOF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2017
Last Update Date: 12/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 28TH ST
ANACORTES WA
98221-2484
US

IV. Provider business mailing address

2405 28TH ST
ANACORTES WA
98221-2484
US

V. Phone/Fax

Practice location:
  • Phone: 360-333-5684
  • Fax: 360-230-3272
Mailing address:
  • Phone: 360-333-5684
  • Fax: 360-230-3272

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: