Provider Demographics
NPI:1700330875
Name:VADEN, MARIKA (EDS, NCSP, CSSP)
Entity Type:Individual
Prefix:
First Name:MARIKA
Middle Name:
Last Name:VADEN
Suffix:
Gender:F
Credentials:EDS, NCSP, CSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13784
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-3784
Mailing Address - Country:US
Mailing Address - Phone:307-264-2022
Mailing Address - Fax:
Practice Address - Street 1:480 S CACHE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8222
Practice Address - Country:US
Practice Address - Phone:307-264-2022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-06
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYCSSP-14103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool