Provider Demographics
NPI:1679261606
Name:RATCLIFF, VANESSA KATRELL (DDIV)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:KATRELL
Last Name:RATCLIFF
Suffix:
Gender:F
Credentials:DDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18637 140TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2617
Mailing Address - Country:US
Mailing Address - Phone:877-595-9977
Mailing Address - Fax:
Practice Address - Street 1:18637 140TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-2617
Practice Address - Country:US
Practice Address - Phone:877-595-9977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YP1600X
NY667183-1163W00000X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No163W00000XNursing Service ProvidersRegistered Nurse