Provider Demographics
NPI:1629944517
Name:POPE, WEDNESDAY ALEXANDRA (MPSS)
Entity type:Individual
Prefix:
First Name:WEDNESDAY
Middle Name:ALEXANDRA
Last Name:POPE
Suffix:
Gender:F
Credentials:MPSS
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 332
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-0332
Mailing Address - Country:US
Mailing Address - Phone:530-957-0140
Mailing Address - Fax:
Practice Address - Street 1:1000 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-3791
Practice Address - Country:US
Practice Address - Phone:530-320-4438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-DLBTGV175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist