Provider Demographics
NPI:1699372185
Name:VANTOL, KATHLEEN MAUREEN
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MAUREEN
Last Name:VANTOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 6TH ST NW
Mailing Address - Street 2:
Mailing Address - City:SIOUX CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:51250-1950
Mailing Address - Country:US
Mailing Address - Phone:712-578-9587
Mailing Address - Fax:
Practice Address - Street 1:548 6TH ST NW
Practice Address - Street 2:
Practice Address - City:SIOUX CENTER
Practice Address - State:IA
Practice Address - Zip Code:51250-1950
Practice Address - Country:US
Practice Address - Phone:712-578-9587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst