Provider Demographics
NPI:1508172826
Name:VANKESSEL, MARYA (BSC)
Entity Type:Individual
Prefix:
First Name:MARYA
Middle Name:
Last Name:VANKESSEL
Suffix:
Gender:F
Credentials:BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2698 NE COURTNEY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7637
Mailing Address - Country:US
Mailing Address - Phone:541-389-6669
Mailing Address - Fax:541-389-8865
Practice Address - Street 1:2698 NE COURTNEY DR STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7637
Practice Address - Country:US
Practice Address - Phone:541-389-6669
Practice Address - Fax:541-389-8865
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR981446237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist