Provider Demographics
NPI:1982160586
Name:MOELLER, VICKI ANN
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:ANN
Last Name:MOELLER
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 1:838 BALLARD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SOLVANG
Mailing Address - State:CA
Mailing Address - Zip Code:93463-9741
Mailing Address - Country:US
Mailing Address - Phone:805-895-4535
Mailing Address - Fax:
Practice Address - Street 1:838 BALLARD CANYON RD
Practice Address - Street 2:
Practice Address - City:SOLVANG
Practice Address - State:CA
Practice Address - Zip Code:93463-9741
Practice Address - Country:US
Practice Address - Phone:805-895-4535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician