Provider Demographics
NPI:1427646702
Name:VANDERPOL, ALYSON J
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:J
Last Name:VANDERPOL
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 1:2308 DEAN DR
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-7521
Mailing Address - Country:US
Mailing Address - Phone:605-630-3405
Mailing Address - Fax:
Practice Address - Street 1:2308 DEAN DR
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-7521
Practice Address - Country:US
Practice Address - Phone:605-630-3405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer