Provider Demographics
NPI:1417001520
Name:WATTENBERG, BETH J
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:J
Last Name:WATTENBERG
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 1:287 RIO LINDO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1973
Mailing Address - Country:US
Mailing Address - Phone:530-895-3509
Mailing Address - Fax:530-895-1119
Practice Address - Street 1:287 RIO LINDO AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1973
Practice Address - Country:US
Practice Address - Phone:530-895-3509
Practice Address - Fax:530-895-1119
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor