Provider Demographics
NPI:1154578938
Name:VATERLAUS, LYNDA KRISTEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:KRISTEN
Last Name:VATERLAUS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:3602 E GREENWAY RD STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4648
Practice Address - Country:US
Practice Address - Phone:602-560-2832
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-004161103TC0700X, 103TH0100X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ620393Medicaid
NE47079871727Medicaid
AZ620393Medicaid
NE47079871726Medicaid
NE47079871729Medicaid