Provider Demographics
NPI:1457472169
Name:NISHIKAWA, WENDY LINN
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:LINN
Last Name:NISHIKAWA
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 1:316 RANCHERIA ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-5439
Mailing Address - Country:US
Mailing Address - Phone:805-893-7323
Mailing Address - Fax:
Practice Address - Street 1:316 RANCHERIA ST APT 2
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-5439
Practice Address - Country:US
Practice Address - Phone:805-893-7323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34527101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health