Provider Demographics
NPI:1265808703
Name:VANDEVENDER, GEORGE FRANK
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:FRANK
Last Name:VANDEVENDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 S. OAKDALE
Mailing Address - Street 2:FAMILY SOLUTIONS
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501
Mailing Address - Country:US
Mailing Address - Phone:541-776-5793
Mailing Address - Fax:541-776-5798
Practice Address - Street 1:153 WIND SONG DRIVE
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502
Practice Address - Country:US
Practice Address - Phone:541-287-0509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst