Healthcare Provider Details

I. General information

NPI: 1346647559
Provider Name (Legal Business Name): VESTA WUNNER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2014
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 W HENDERSON ST
EUREKA CA
95501-4024
US

IV. Provider business mailing address

123 W HENDERSON ST
EUREKA CA
95501-4024
US

V. Phone/Fax

Practice location:
  • Phone: 707-268-2900
  • Fax:
Mailing address:
  • Phone: 707-268-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW28928
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: