Provider Demographics
NPI:1477128197
Name:VANDEVENTER, MEGAN (RBT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:VANDEVENTER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4655 ROSEBUD LN
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-9366
Mailing Address - Country:US
Mailing Address - Phone:812-297-9889
Mailing Address - Fax:
Practice Address - Street 1:4655 ROSEBUD LN
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-9366
Practice Address - Country:US
Practice Address - Phone:812-297-9889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-20-126235106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician