Provider Demographics
NPI:1265790745
Name:JIROUTEK, VANESSA LYNN (BS)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:LYNN
Last Name:JIROUTEK
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MRS
Other - First Name:VANESSA
Other - Middle Name:LYNN
Other - Last Name:PAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:43732 WINDROSE PL
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-2357
Mailing Address - Country:US
Mailing Address - Phone:661-718-3049
Mailing Address - Fax:
Practice Address - Street 1:44447 10TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3324
Practice Address - Country:US
Practice Address - Phone:661-726-2630
Practice Address - Fax:661-723-3211
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist