Provider Demographics
NPI:1588922637
Name:WUNDERLICH, RENNER
Entity type:Individual
Prefix:MR
First Name:RENNER
Middle Name:
Last Name:WUNDERLICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3099 HIDDEN VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93108-1620
Mailing Address - Country:US
Mailing Address - Phone:805-535-8815
Mailing Address - Fax:
Practice Address - Street 1:3099 HIDDEN VALLEY LN
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93108-1620
Practice Address - Country:US
Practice Address - Phone:805-535-8815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALC280011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical