Provider Demographics
NPI:1669717963
Name:VONDEYLEN, KAREN A N (LISW)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:A N
Last Name:VONDEYLEN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 STATE HIGHWAY 108
Mailing Address - Street 2:SUITE A
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-8200
Mailing Address - Country:US
Mailing Address - Phone:419-335-3732
Mailing Address - Fax:
Practice Address - Street 1:7320 STATE HIGHWAY 108
Practice Address - Street 2:SUITE A
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-8200
Practice Address - Country:US
Practice Address - Phone:419-335-3732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.08003411041C0700X
OHI.16006901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical