Provider Demographics
NPI:1982592218
Name:WILCOX, VANESSA RENEE
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:RENEE
Last Name:WILCOX
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 1:4120 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46408-2428
Mailing Address - Country:US
Mailing Address - Phone:219-789-1461
Mailing Address - Fax:
Practice Address - Street 1:10419 CALUMET AVE STE B
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-4059
Practice Address - Country:US
Practice Address - Phone:219-245-7970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician