Provider Demographics
NPI:1679801393
Name:VANDERPLOEG, KASSI JOY (BA, BCABA)
Entity Type:Individual
Prefix:MRS
First Name:KASSI
Middle Name:JOY
Last Name:VANDERPLOEG
Suffix:
Gender:F
Credentials:BA, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36468 EMERALD COAST PKWY
Mailing Address - Street 2:SUITE 2101
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-4799
Mailing Address - Country:US
Mailing Address - Phone:850-837-1200
Mailing Address - Fax:850-269-2341
Practice Address - Street 1:36468 EMERALD COAST PKWY
Practice Address - Street 2:SUITE 2101
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-4799
Practice Address - Country:US
Practice Address - Phone:850-837-1200
Practice Address - Fax:850-269-2341
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-09-3565103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst