Provider Demographics
NPI:1184240384
Name:WADERKER PERRY, PATSY JOAN (BA, MSW, PSYD, ACSW)
Entity type:Individual
Prefix:
First Name:PATSY
Middle Name:JOAN
Last Name:WADERKER PERRY
Suffix:
Gender:F
Credentials:BA, MSW, PSYD, ACSW
Other - Prefix:
Other - First Name:PATSY
Other - Middle Name:JOAN
Other - Last Name:WADERKER PERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA, MSW, PSYD, ACSW
Mailing Address - Street 1:1424 W CESAR CHAVEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-3922
Mailing Address - Country:US
Mailing Address - Phone:559-237-1444
Mailing Address - Fax:
Practice Address - Street 1:1424 W CESAR CHAVEZ BLVD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-3922
Practice Address - Country:US
Practice Address - Phone:559-237-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA131317104100000X
225C00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor