Provider Demographics
NPI:1932918414
Name:VANDUSEN, MEGAN MARIE (CO61547151)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:VANDUSEN
Suffix:
Gender:F
Credentials:CO61547151
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 E CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3403
Mailing Address - Country:US
Mailing Address - Phone:360-681-8463
Mailing Address - Fax:
Practice Address - Street 1:381 ROUPE RD
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-7949
Practice Address - Country:US
Practice Address - Phone:360-360-4602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61547151101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty