Healthcare Provider Details

I. General information

NPI: 1609919489
Provider Name (Legal Business Name): LAUREEN ANNE WIERENGA CAADE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14660 OXNARD ST.
VAN NUYS CA
91411
US

IV. Provider business mailing address

14660 OXNARD ST
VAN NUYS CA
91411-3119
US

V. Phone/Fax

Practice location:
  • Phone: 818-901-4836
  • Fax: 818-376-0044
Mailing address:
  • Phone: 818-901-4836
  • Fax: 818-376-0044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number970217
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: