Provider Demographics
NPI:1023716404
Name:WARDLE, ANNIE GENE BANKS (MSW)
Entity type:Individual
Prefix:
First Name:ANNIE GENE
Middle Name:BANKS
Last Name:WARDLE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 ORCHARD WAY
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-3553
Mailing Address - Country:US
Mailing Address - Phone:209-637-7310
Mailing Address - Fax:
Practice Address - Street 1:763 ORCHARD WAY
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-3553
Practice Address - Country:US
Practice Address - Phone:209-637-7310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health