Provider Demographics
NPI:1154816726
Name:WENKE, HEATHER
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:WENKE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18522 OUTER HWY 18 STE 207
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2321
Mailing Address - Country:US
Mailing Address - Phone:442-327-9172
Mailing Address - Fax:
Practice Address - Street 1:18522 OUTER HWY 18 STE 207
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2321
Practice Address - Country:US
Practice Address - Phone:442-327-9172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst