Provider Demographics
NPI:1922358092
Name:WAHL, VANESSA M
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:M
Last Name:WAHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 AVENIDA ENCINAS
Mailing Address - Street 2:250
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-4386
Mailing Address - Country:US
Mailing Address - Phone:760-729-5433
Mailing Address - Fax:760-621-3203
Practice Address - Street 1:5050 AVENIDA ENCINAS
Practice Address - Street 2:250
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-4386
Practice Address - Country:US
Practice Address - Phone:760-729-5433
Practice Address - Fax:760-621-3203
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP19887235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist