Provider Demographics
NPI:1770373433
Name:VANDENBERG, SUSAN
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:VANDENBERG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9715 CROWS NEST LN
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44253-9555
Mailing Address - Country:US
Mailing Address - Phone:216-386-3000
Mailing Address - Fax:
Practice Address - Street 1:9715 CROWS NEST LN
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44253-9555
Practice Address - Country:US
Practice Address - Phone:216-386-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251X00000XAgenciesSupports Brokerage