Provider Demographics
NPI:1497004097
Name:SIGSTAD, VONDA ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:VONDA
Middle Name:ANN
Last Name:SIGSTAD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1219
Mailing Address - Street 2:
Mailing Address - City:MURREITA
Mailing Address - State:CA
Mailing Address - Zip Code:92564
Mailing Address - Country:US
Mailing Address - Phone:951-834-4204
Mailing Address - Fax:
Practice Address - Street 1:27851 BRADLEY RD
Practice Address - Street 2:STE 101
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92586-2286
Practice Address - Country:US
Practice Address - Phone:951-473-0307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 252241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical