Provider Demographics
NPI:1740665629
Name:VANDERBURG, BRANDY PENELOPE
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:PENELOPE
Last Name:VANDERBURG
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:BRANDY
Other - Middle Name:PENELOPE
Other - Last Name:MILDFELDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 E 62ND AVE
Mailing Address - Street 2:APT 146
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-1104
Mailing Address - Country:US
Mailing Address - Phone:720-276-0778
Mailing Address - Fax:
Practice Address - Street 1:1333 IRIS AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-2226
Practice Address - Country:US
Practice Address - Phone:303-245-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health