Provider Demographics
NPI:1144662305
Name:VANDUSER, MAIDA DEE
Entity type:Individual
Prefix:
First Name:MAIDA
Middle Name:DEE
Last Name:VANDUSER
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 1:110 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:OK
Mailing Address - Zip Code:74873-4234
Mailing Address - Country:US
Mailing Address - Phone:405-371-0417
Mailing Address - Fax:
Practice Address - Street 1:905 E WILSON ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-4165
Practice Address - Country:US
Practice Address - Phone:405-878-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor