Provider Demographics
NPI:1801551569
Name:HOOGENDOORN, VANESSA
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:HOOGENDOORN
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 1:6209 E SILVER MAPLE CIR STE 102
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-7807
Mailing Address - Country:US
Mailing Address - Phone:605-799-6182
Mailing Address - Fax:844-602-4652
Practice Address - Street 1:6209 E SILVER MAPLE CIR STE 102
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-7807
Practice Address - Country:US
Practice Address - Phone:605-799-6182
Practice Address - Fax:844-602-4652
Is Sole Proprietor?:No
Enumeration Date:2021-11-07
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC20550101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health