Provider Demographics
NPI:1740317494
Name:PAELICKE, VANESSA LYNN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:LYNN
Last Name:PAELICKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 LA ROCHELLE CT
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-8315
Mailing Address - Country:US
Mailing Address - Phone:281-326-3638
Mailing Address - Fax:
Practice Address - Street 1:2413 LA ROCHELLE CT
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:TX
Practice Address - Zip Code:77586-8315
Practice Address - Country:US
Practice Address - Phone:281-326-3638
Practice Address - Fax:281-326-3638
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX372581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1870776-01Medicaid