Provider Demographics
NPI:1376100867
Name:WOBENSMITH, LADA E
Entity Type:Individual
Prefix:
First Name:LADA
Middle Name:E
Last Name:WOBENSMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LADA
Other - Middle Name:E
Other - Last Name:WIKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1429 ZEPOL RD APT 106
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-7137
Mailing Address - Country:US
Mailing Address - Phone:901-402-6195
Mailing Address - Fax:
Practice Address - Street 1:1429 ZEPOL RD APT 106
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-7137
Practice Address - Country:US
Practice Address - Phone:901-402-6195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician