Provider Demographics
NPI:1376013987
Name:VANDERHEID-NYE, ALEXANDRA (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:VANDERHEID-NYE
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63156 LANCASTER ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7066
Mailing Address - Country:US
Mailing Address - Phone:541-728-3811
Mailing Address - Fax:
Practice Address - Street 1:63156 LANCASTER ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7066
Practice Address - Country:US
Practice Address - Phone:541-728-3811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABA-B-10241985103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst