Healthcare Provider Details

I. General information

NPI: 1023773546
Provider Name (Legal Business Name): WENDY D. VAZQUEZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 E CARSON ST STE A
COLUSA CA
95932-2880
US

IV. Provider business mailing address

162 E CARSON ST STE A
COLUSA CA
95932-2880
US

V. Phone/Fax

Practice location:
  • Phone: 530-458-0520
  • Fax: 530-458-7751
Mailing address:
  • Phone: 530-458-0520
  • Fax: 530-458-7751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number101001
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: