Healthcare Provider Details

I. General information

NPI: 1780153429
Provider Name (Legal Business Name): STEPHANIE FENDLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2018
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MCHENRY VILLAGE WAY STE 11B
MODESTO CA
95350-4341
US

IV. Provider business mailing address

1700 MCHENRY VILLAGE WAY STE 11B
MODESTO CA
95350-4341
US

V. Phone/Fax

Practice location:
  • Phone: 209-550-5850
  • Fax:
Mailing address:
  • Phone: 209-550-5850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: