Provider Demographics
NPI:1710176847
Name:VANDY, MICHAELYN BETTASSO (MS)
Entity Type:Individual
Prefix:MRS
First Name:MICHAELYN
Middle Name:BETTASSO
Last Name:VANDY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-9827
Mailing Address - Country:US
Mailing Address - Phone:773-317-5519
Mailing Address - Fax:
Practice Address - Street 1:1225 WILLOW WAY
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-9827
Practice Address - Country:US
Practice Address - Phone:773-317-5519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist