Provider Demographics
NPI:1164725966
Name:VENDT, MELISSA M (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:M
Last Name:VENDT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 PENNINGTON LN
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-6915
Mailing Address - Country:US
Mailing Address - Phone:636-675-4032
Mailing Address - Fax:
Practice Address - Street 1:242 PENNINGTON LN
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-6915
Practice Address - Country:US
Practice Address - Phone:636-675-4032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-03-1453103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst