Provider Demographics
NPI:1699090472
Name:VANDERLOO, MINDY JO (CPCI)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:JO
Last Name:VANDERLOO
Suffix:
Gender:F
Credentials:CPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 S 1100 E STE 203
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2463
Mailing Address - Country:US
Mailing Address - Phone:801-510-5231
Mailing Address - Fax:
Practice Address - Street 1:1390 S 1100 E STE 203
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-2463
Practice Address - Country:US
Practice Address - Phone:801-510-5231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7380258-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health