Provider Demographics
NPI:1720352966
Name:VANDEN BOS, VANESSA (LMT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:VANDEN BOS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1695 ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-9693
Mailing Address - Country:US
Mailing Address - Phone:541-380-0885
Mailing Address - Fax:
Practice Address - Street 1:202 OAK ST
Practice Address - Street 2:SUITE 250
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2071
Practice Address - Country:US
Practice Address - Phone:541-380-0885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12440225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist