Healthcare Provider Details

I. General information

NPI: 1497957294
Provider Name (Legal Business Name): MS. WENDY JO TWICHELL-O'NEAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 I ST
DAVIS CA
95616-4213
US

IV. Provider business mailing address

1214 E 8TH ST
DAVIS CA
95616-3902
US

V. Phone/Fax

Practice location:
  • Phone: 530-758-4078
  • Fax:
Mailing address:
  • Phone: 530-867-1846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: