Healthcare Provider Details

I. General information

NPI: 1124251558
Provider Name (Legal Business Name): VANESSA MONTEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 6TH ST SE
WILLMAR MN
56201-4675
US

IV. Provider business mailing address

2161 NW MILITARY HWY
SAN ANTONIO TX
78213-1878
US

V. Phone/Fax

Practice location:
  • Phone: 320-235-4613
  • Fax: 855-625-7406
Mailing address:
  • Phone: 210-341-3336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number31594
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number55037
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: