Provider Demographics
NPI:1487267688
Name:HERZOG, VANESSA J (MA, RP, BS, CAAP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:J
Last Name:HERZOG
Suffix:
Gender:F
Credentials:MA, RP, BS, CAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 W AXTON RD
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-9100
Mailing Address - Country:US
Mailing Address - Phone:303-525-9558
Mailing Address - Fax:
Practice Address - Street 1:1303 COMMERCIAL ST STE 4
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4348
Practice Address - Country:US
Practice Address - Phone:360-922-6977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61078137101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health