Provider Demographics
NPI:1306136635
Name:WULFF-WESTERHEIDE, RENEE ANNETTE
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:ANNETTE
Last Name:WULFF-WESTERHEIDE
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 1:33962 CALLE DE BONANZA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-5025
Mailing Address - Country:US
Mailing Address - Phone:949-547-8226
Mailing Address - Fax:858-444-8827
Practice Address - Street 1:29122 RANCHO VIEJO RD
Practice Address - Street 2:#204
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1018
Practice Address - Country:US
Practice Address - Phone:949-547-8226
Practice Address - Fax:858-444-8827
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-07-3972103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst