Provider Demographics
NPI:1356121198
Name:BAECHTEL, VANESSA LEA (MA)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:LEA
Last Name:BAECHTEL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4412 KELLIA LN NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-4224
Mailing Address - Country:US
Mailing Address - Phone:505-730-0342
Mailing Address - Fax:
Practice Address - Street 1:4412 KELLIA LN NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-4224
Practice Address - Country:US
Practice Address - Phone:505-730-0342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician