Provider Demographics
NPI:1619099751
Name:SODERBERG, VANESSA EVELYN (MS LMFT)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:EVELYN
Last Name:SODERBERG
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2646
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-2646
Mailing Address - Country:US
Mailing Address - Phone:360-387-5136
Mailing Address - Fax:360-387-1604
Practice Address - Street 1:453 HOUSE PL
Practice Address - Street 2:
Practice Address - City:CAMANO ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98282-8579
Practice Address - Country:US
Practice Address - Phone:360-387-5136
Practice Address - Fax:360-387-1644
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00000966106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist