Provider Demographics
NPI:1093524977
Name:WEKESA, STEPHANIE NASWA
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:NASWA
Last Name:WEKESA
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 1:2911 VAN HORNE WAY SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-3708
Mailing Address - Country:US
Mailing Address - Phone:785-802-9770
Mailing Address - Fax:785-802-9770
Practice Address - Street 1:2911 VAN HORNE WAY SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-3708
Practice Address - Country:US
Practice Address - Phone:785-802-9770
Practice Address - Fax:785-802-9770
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician