Provider Demographics
NPI:1740027267
Name:VANDUSEN, GRACE DELIA (LPC)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:DELIA
Last Name:VANDUSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18960 W 117TH ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-6561
Mailing Address - Country:US
Mailing Address - Phone:913-215-4418
Mailing Address - Fax:
Practice Address - Street 1:11261 STRANG LINE RD
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-4040
Practice Address - Country:US
Practice Address - Phone:913-488-3663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04729101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional