Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 15631 | CA |
NPI | 1326683046 |
---|---|
Provider Name | Vanessa Ladson |
First Address | Modesto, CA 95355-3597 |
Second Address | San Jose, CA 95126-1136 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2019 |
Last Update Date | 18/11/2019 |