Provider Demographics
NPI:1104174218
Name:VENDEGNA, HEIDI KAM
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:KAM
Last Name:VENDEGNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12252 BANNOCK CIR
Mailing Address - Street 2:UNIT F
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-3189
Mailing Address - Country:US
Mailing Address - Phone:303-525-1708
Mailing Address - Fax:
Practice Address - Street 1:7878 WADSWORTH BLVD
Practice Address - Street 2:#101
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-2146
Practice Address - Country:US
Practice Address - Phone:303-432-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker