Provider Demographics
NPI:1851422653
Name:MESENBRINK, RHONDA GAYLE (CADA11)
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:GAYLE
Last Name:MESENBRINK
Suffix:
Gender:F
Credentials:CADA11
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 OAKSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1710
Mailing Address - Country:US
Mailing Address - Phone:209-525-5613
Mailing Address - Fax:209-525-5655
Practice Address - Street 1:424 E HACKETT RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95358-9493
Practice Address - Country:US
Practice Address - Phone:209-525-5613
Practice Address - Fax:209-525-5655
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA8480203101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)