Provider Demographics
NPI:1295182202
Name:WILSON-TAYLOR, DEVENA
Entity Type:Individual
Prefix:MS
First Name:DEVENA
Middle Name:
Last Name:WILSON-TAYLOR
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 1:362 HURST AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-3419
Mailing Address - Country:US
Mailing Address - Phone:805-289-3170
Mailing Address - Fax:805-289-3202
Practice Address - Street 1:5740 RALSTON ST STE 200
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6009
Practice Address - Country:US
Practice Address - Phone:805-289-3170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker