Provider Demographics
NPI:1205178019
Name:VANDER STOEP, CAROL BETH (RDH)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:BETH
Last Name:VANDER STOEP
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 TALL OAKS TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-9306
Mailing Address - Country:US
Mailing Address - Phone:512-288-3331
Mailing Address - Fax:
Practice Address - Street 1:11 TALL OAKS TRL
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737-9306
Practice Address - Country:US
Practice Address - Phone:512-288-3331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4863174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist