Healthcare Provider Details

I. General information

NPI: 1780098772
Provider Name (Legal Business Name): VANESSA RAMSDELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VANESSA HAYNES LCSW

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 03/26/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 FRONTIER DR
AMMON ID
83406-4788
US

IV. Provider business mailing address

4220 FRONTIER DR
AMMON ID
83406-4788
US

V. Phone/Fax

Practice location:
  • Phone: 714-326-7270
  • Fax:
Mailing address:
  • Phone: 714-326-7270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW87427
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW87427
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-39811
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: