MEDICARE: BRE MICHELLE VANDER WOUDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1649088733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRE MICHELLE VANDER WOUDE

Provider Business Mailing Address
First Line	:	3700 ETHEL AVE
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76707-1632
Country	:	US
Telephone Number	:	254-715-1187
Fax Number	:

Provider Business Practice Location Address
First Line	:	15140 BADGER RANCH BLVD
Second Line	:
City	:	WOODWAY
State	:	TX
Zip	:	76712-8983
Country	:	US
Telephone Number	:	254-545-2674
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2024
Last Update Date	:	12/21/2024

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Directions to “ BRE MICHELLE VANDER WOUDE ” Practice Location

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