Provider Demographics
NPI:1518039619
Name:VANDENBERG, LAURA JEAN (LADC)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JEAN
Last Name:VANDENBERG
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 SOUTH 6TH, STREET, SUITE 1
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68434
Mailing Address - Country:US
Mailing Address - Phone:402-643-3343
Mailing Address - Fax:
Practice Address - Street 1:729 SEWARD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434
Practice Address - Country:US
Practice Address - Phone:402-643-3343
Practice Address - Fax:402-643-4048
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE422101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47052851503Medicaid
NE47052851514Medicaid
NE47052851501Medicaid
NE47052851504Medicaid
NE10025668200Medicaid
NE47052851506Medicaid
NE47052851510Medicaid
NE85311OtherBCBS
NE10025208600Medicaid
NE47052851509Medicaid
NE10025208500Medicaid
NE470528515-08Medicaid
NE47052851515Medicaid
NE47052851500Medicaid