Provider Demographics
NPI:1225660293
Name:GALLEGOS, VANESSA MARIE
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:MARIE
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3329 E BAYAUD AVE APT 904
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3089
Mailing Address - Country:US
Mailing Address - Phone:719-766-2228
Mailing Address - Fax:
Practice Address - Street 1:2851 S PARKER RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2736
Practice Address - Country:US
Practice Address - Phone:720-791-5488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0-23-14715106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst