Provider Demographics
NPI:1396635900
Name:PESEK, AUDREY GRACE (ASW)
Entity type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:GRACE
Last Name:PESEK
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 CERRO VERDE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-4905
Mailing Address - Country:US
Mailing Address - Phone:408-797-6184
Mailing Address - Fax:
Practice Address - Street 1:605 TENNANT AVE
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-5529
Practice Address - Country:US
Practice Address - Phone:408-778-5120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1313051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical