Provider Demographics
NPI:1306677570
Name:WREN, RANDI L
Entity type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:L
Last Name:WREN
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 1:330 PRIMROSE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-4026
Mailing Address - Country:US
Mailing Address - Phone:650-477-8810
Mailing Address - Fax:
Practice Address - Street 1:330 PRIMROSE RD STE 205
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4026
Practice Address - Country:US
Practice Address - Phone:650-477-8810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
CA256101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral