Provider Demographics
NPI:1154628550
Name:VAN DE HEY, ERIN (MA, BCBA)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:
Last Name:VAN DE HEY
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W5846 HEDRICK DR
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-9386
Mailing Address - Country:US
Mailing Address - Phone:215-620-9857
Mailing Address - Fax:
Practice Address - Street 1:W5846 HEDRICK DR
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-9386
Practice Address - Country:US
Practice Address - Phone:215-620-9857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst