Provider Demographics
NPI:1477715522
Name:VANDERLAAN, LINDA L (PHD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:L
Last Name:VANDERLAAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 RIMPAU AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-7520
Mailing Address - Country:US
Mailing Address - Phone:951-279-7099
Mailing Address - Fax:
Practice Address - Street 1:1451 RIMPAU AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-7520
Practice Address - Country:US
Practice Address - Phone:951-279-7099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13549103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical