Provider Demographics
NPI:1093022345
Name:VANDENBOGAARD, JAY (MS, NCC, CADC III)
Entity Type:Individual
Prefix:MRS
First Name:JAY
Middle Name:
Last Name:VANDENBOGAARD
Suffix:
Gender:F
Credentials:MS, NCC, CADC III
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:ARZADON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2225 PACIFIC BOULEVARD SE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321
Mailing Address - Country:US
Mailing Address - Phone:541-704-0762
Mailing Address - Fax:
Practice Address - Street 1:2225 PACIFIC BOULEVARD SE
Practice Address - Street 2:SUITE 207
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321
Practice Address - Country:US
Practice Address - Phone:541-704-0762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR1427101Y00000X, 101YM0800X, 101YP2500X
OR07-12-61101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR064OtherSTATE OF OREGON ADDICTION&MENTAL HEALTH PROVIDER NUMBER