Provider Demographics
NPI:1902263544
Name:WENK, DESERAE TABIATHA
Entity type:Individual
Prefix:
First Name:DESERAE
Middle Name:TABIATHA
Last Name:WENK
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:PO BOX 442
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-0442
Mailing Address - Country:US
Mailing Address - Phone:916-805-9203
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 442
Practice Address - Street 2:
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-0442
Practice Address - Country:US
Practice Address - Phone:916-805-9203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker