Madison Vandervennet, M.S., QBHP

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Practice address

4998 Tiohero Blvd
Clarkston, MI 48348-3382

Phone

(248) 807-3102

NPI assigned

Apr 17, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1460851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566172800000",
    "number": "1669826582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4998 TIOHERO BLVD",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483483382",
            "telephone_number": "248-807-3102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4998 TIOHERO BLVD",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483483382",
            "telephone_number": "248-807-3102"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5093 Waterford Rd",
            "address_purpose": "LOCATION",
            "city": "Clarkston",
            "state": "MI",
            "postal_code": "483463460",
            "country_code": "US",
            "telephone_number": "248-807-3102",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDERVENNET",
        "first_name": "MADISON",
        "credential": "M.S., QBHP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-17",
        "last_updated": "2019-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "247200000X",
            "taxonomy_group": "",
            "desc": "Technician, Other",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in Clarkston, MI
• Providers in Clarkston, MI by specialty
• Behavior Analyst in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.