Provider Demographics
NPI:1851779789
Name:VANDENHEUVEL, KALLI
Entity type:Individual
Prefix:MISS
First Name:KALLI
Middle Name:
Last Name:VANDENHEUVEL
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:W3068 KORTNEY LN
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:WI
Mailing Address - Zip Code:54165-8554
Mailing Address - Country:US
Mailing Address - Phone:920-843-2987
Mailing Address - Fax:
Practice Address - Street 1:W3068 KORTNEY LANE
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:WI
Practice Address - Zip Code:54165
Practice Address - Country:US
Practice Address - Phone:920-843-2987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer