Provider Demographics
NPI:1396133567
Name:VANDERMEULEN, HEIDI LYNN (MS ED,, TVI)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:LYNN
Last Name:VANDERMEULEN
Suffix:
Gender:F
Credentials:MS ED,, TVI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 DELAND DR
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-1918
Mailing Address - Country:US
Mailing Address - Phone:315-269-7377
Mailing Address - Fax:
Practice Address - Street 1:415 DELAND DRIVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502
Practice Address - Country:US
Practice Address - Phone:315-269-7377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1859165225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist