Provider Demographics
NPI:1689642829
Name:VANDERHEYDEN, ERICA E (PSYD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:E
Last Name:VANDERHEYDEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2837
Mailing Address - Country:US
Mailing Address - Phone:602-495-4577
Mailing Address - Fax:602-217-3549
Practice Address - Street 1:1920 N HIGLEY RD
Practice Address - Street 2:SUITE 106
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-1623
Practice Address - Country:US
Practice Address - Phone:480-543-2688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3439103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ704206Medicaid
Z120231Medicare PIN
Z74928Medicare PIN
AZ704206Medicaid