Provider Demographics
NPI:1538020680
Name:LAZCANO, VANESSA MARIE
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:MARIE
Last Name:LAZCANO
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 1:6828 W HERA WAY
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-4220
Mailing Address - Country:US
Mailing Address - Phone:559-805-2948
Mailing Address - Fax:
Practice Address - Street 1:6828 W HERA WAY
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84081-4220
Practice Address - Country:US
Practice Address - Phone:559-805-2948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-19
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTRBT-25-491263106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician