Provider Demographics
NPI:1033827225
Name:LEPAGE-WU, EMILY IRENE (MS, LEP, ABSNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:IRENE
Last Name:LEPAGE-WU
Suffix:
Gender:F
Credentials:MS, LEP, ABSNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-0384
Mailing Address - Country:US
Mailing Address - Phone:650-394-6021
Mailing Address - Fax:
Practice Address - Street 1:760 POLHEMUS RD
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3938
Practice Address - Country:US
Practice Address - Phone:650-349-8717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3859103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool