Provider Demographics
NPI:1326107186
Name:GALLO, WENDY EVE (MFT)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:EVE
Last Name:GALLO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45310 PACIFICA DR UNIT D
Mailing Address - Street 2:
Mailing Address - City:CASPAR
Mailing Address - State:CA
Mailing Address - Zip Code:95420-0204
Mailing Address - Country:US
Mailing Address - Phone:707-409-0177
Mailing Address - Fax:
Practice Address - Street 1:1400 EMELINE AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-1976
Practice Address - Country:US
Practice Address - Phone:831-454-4170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94160106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC 70044FOtherSANTA CRUZ COUNTY MEDI-CAL PROVDER GROUP#
CAFHC 70042FOtherSANTA CRUZ COUNTY MEDI-CAL PROVDER GROUP#
CAZZZ91891ZOtherSANTA CRUZ COUNTY MEDICARE GROUP PTAN#
CAZZZ91892ZOtherSANTA CRUZ COUNTY MEDICARE GROUP PTAN#
CAZZZ92069ZOtherSANTA CRUZ COUNTY MEDICARE GROUP PTAN#