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Contact Information

WANDA R BOUTTE
5241 MEDEA WAY
ANTIOCH, CA94531-8727
 Phone: 510-469-1136
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

1041C0700X 80 Licensed Clinical Social Worker
 

Developmental Therapist

222Q00000X
Indicates primary specialty

NPI Profile & details for WANDA R BOUTTE · (Female)

NPI Number 1376980227
Status Active
Credentials
Entity Individual
Enumeration date 06/02/2013
Last updated 11/22/2024 - More than a year ago
Sole proprietor 1 Yes
Identifiers
  • CA License # 293646
  • CA Other 1376980227 ALAMEDA COUNTY BEHAVIORAL HEALTH CARE SERVICES
  • CA Other CA206171 NORIDIAN MEDICARE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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