Provider Demographics
NPI:1588705941
Name:WILKENS, VANESSA DENISE (CCJS)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:DENISE
Last Name:WILKENS
Suffix:
Gender:F
Credentials:CCJS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 S. SECOND STREET APT. A
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-0563
Mailing Address - Country:US
Mailing Address - Phone:323-997-7320
Mailing Address - Fax:323-293-3327
Practice Address - Street 1:3875 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90062-1105
Practice Address - Country:US
Practice Address - Phone:323-290-4361
Practice Address - Fax:323-293-3327
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner