Provider Demographics
NPI:1992854913
Name:VONDERHAAR, WILLIAM F (PHD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:F
Last Name:VONDERHAAR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5047 PARK RIDGE COURT
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069
Mailing Address - Country:US
Mailing Address - Phone:513-860-1970
Mailing Address - Fax:513-860-4023
Practice Address - Street 1:7584 CINCINNATI COLUMBUS ROAD
Practice Address - Street 2:#211
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241
Practice Address - Country:US
Practice Address - Phone:513-779-6018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3479103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0751922Medicaid
OH0751922Medicaid
R71081Medicare UPIN