Individual
VANESSA BAUTISTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5253 10TH ARMORED LOOP, FORT MOORE, GA 31905-7088
(831) 245-8662
Mailing address
5253 10TH ARMORED LOOP, FORT MOORE, GA 31905-7088
(831) 245-8662
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
72067
TX
Other
Enumeration date
10/19/2024
Last updated
10/19/2024
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