Provider Demographics
NPI:1780943779
Name:VANDYKE, NATALLIE JOY (BA)
Entity type:Individual
Prefix:MRS
First Name:NATALLIE
Middle Name:JOY
Last Name:VANDYKE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:NATALLIE
Other - Middle Name:J
Other - Last Name:BOBZIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:PO BOX 1234
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-8234
Mailing Address - Country:US
Mailing Address - Phone:503-397-5211
Mailing Address - Fax:503-397-5373
Practice Address - Street 1:271 COLUMBIA BLVD
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-2021
Practice Address - Country:US
Practice Address - Phone:503-397-0391
Practice Address - Fax:503-366-1067
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR12390Medicaid