Kathryn Denise Vandenberg, BCBA
Individual provider Active NPI Behavior Analyst · Santa Clara, UT
NPI 1104128362 · NPPES record last updated Jul 5, 2023
Key facts
- NPI
- 1104128362
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Analyst 103K00000X
- License
- 13419436-2506 (UT)
- Practice address
- 3641 Vista View Cir
Santa Clara, UT 84765-5655 - Phone
- (435) 767-7929
- NPI assigned
- Nov 21, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13419436-2506 | UT | MD | Behavioral Analyst |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| 1St Step Applied Behavior Analysts, Inc | Past | Accepting new patients | |
| 1St Step Applied Behavior Analysts, Inc. | Behavior Analyst | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 13419436-2506 | UT | Yes |
Addresses
Primary practice location
3641 Vista View Cir
Santa Clara, UT 84765-5655
Mailing address
PO Box 2000
Shingle Springs, CA 95682-2000
Phone (530) 748-9395
Other practice location 1
3808 De Sabla Rd
Cameron Park, CA 95682-8608
Phone (530) 748-9395
Other providers in Santa Clara, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 5, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.