Healthcare Provider Details

I. General information

NPI: 1679316616
Provider Name (Legal Business Name): EFFIE MAY VILCONE MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. EFFIE MAY HANSON

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MYRTLE AVENUE
EUREKA CA
95501-1219
US

IV. Provider business mailing address

901 MYRTLE AVENUE
EUREKA CA
95501-1219
US

V. Phone/Fax

Practice location:
  • Phone: 707-445-7000
  • Fax: 707-445-7143
Mailing address:
  • Phone: 707-445-7000
  • Fax: 707-445-7143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: