Provider Demographics
NPI:1548447212
Name:BAUMANN, VENESSA ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:VENESSA
Middle Name:ANN
Last Name:BAUMANN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:VENESSA
Other - Middle Name:ANN
Other - Last Name:MCCLENDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5400 E OLYMPIC BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90022-5186
Mailing Address - Country:US
Mailing Address - Phone:323-728-9966
Mailing Address - Fax:323-887-1082
Practice Address - Street 1:5400 E OLYMPIC BLVD STE 140
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90022-5186
Practice Address - Country:US
Practice Address - Phone:323-728-9966
Practice Address - Fax:323-887-1082
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23454103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist