Healthcare Provider Details

I. General information

NPI: 1760250005
Provider Name (Legal Business Name): ANDREA NICOLE WULLSCHLEGER ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2023
Last Update Date: 08/26/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 S MOONEY BLVD
VISALIA CA
93277-9396
US

IV. Provider business mailing address

1830 S CENTRAL ST. VISALIA
VISALIA CA
93277-4418
US

V. Phone/Fax

Practice location:
  • Phone: 559-747-3984
  • Fax:
Mailing address:
  • Phone: 559-730-2969
  • Fax: 559-730-2991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW123773
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: