Provider Demographics
NPI:1972969400
Name:VANDER VELDEN, EMILY (LPC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:VANDER VELDEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7818 BIG SKY DR
Mailing Address - Street 2:#101
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-3524
Mailing Address - Country:US
Mailing Address - Phone:608-203-6267
Mailing Address - Fax:608-203-6696
Practice Address - Street 1:7818 BIG SKY DR
Practice Address - Street 2:#101
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-3524
Practice Address - Country:US
Practice Address - Phone:608-203-6267
Practice Address - Fax:608-203-6696
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6057-125101YM0800X
WI17758-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)