Provider Demographics
NPI:1386685154
Name:VAN VLIET, DENNIS DALE (AUD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:DALE
Last Name:VAN VLIET
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17021 YORBA LINDA BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-3743
Mailing Address - Country:US
Mailing Address - Phone:714-579-0717
Mailing Address - Fax:
Practice Address - Street 1:17021 YORBA LINDA BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-3743
Practice Address - Country:US
Practice Address - Phone:714-579-0717
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU368231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist