Provider Demographics
NPI:1962017848
Name:VANSCHAFFEL, KATHERINE MELINDA
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MELINDA
Last Name:VANSCHAFFEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:MELINDA
Other - Last Name:VANSCHAFFEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3363 STALLINGS RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-4333
Mailing Address - Country:US
Mailing Address - Phone:912-282-3149
Mailing Address - Fax:
Practice Address - Street 1:5921 BEMISS RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-7520
Practice Address - Country:US
Practice Address - Phone:352-478-8179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician