Provider Demographics
NPI:1164667416
Name:RODRIGUE, VANESSA LYNN
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:LYNN
Last Name:RODRIGUE
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 1:1200 MT DIABLO BLVD
Mailing Address - Street 2:313
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4852
Mailing Address - Country:US
Mailing Address - Phone:925-943-1794
Mailing Address - Fax:
Practice Address - Street 1:1200 MT DIABLO BLVD
Practice Address - Street 2:313
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4852
Practice Address - Country:US
Practice Address - Phone:925-943-1794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health