Provider Demographics
NPI:1821570607
Name:VANG, LINDA (BCBA, MED)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:VANG
Suffix:
Gender:F
Credentials:BCBA, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5072 E HOME AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1948
Mailing Address - Country:US
Mailing Address - Phone:916-402-1090
Mailing Address - Fax:
Practice Address - Street 1:5072 E HOME AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1948
Practice Address - Country:US
Practice Address - Phone:916-402-1090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABCBA-1-19-34415103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst