Provider Demographics
NPI:1003201187
Name:MARSH, WENDELA (MA, BCBA, LEP)
Entity Type:Individual
Prefix:
First Name:WENDELA
Middle Name:
Last Name:MARSH
Suffix:
Gender:F
Credentials:MA, BCBA, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 WAKE FOREST CT
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2155
Mailing Address - Country:US
Mailing Address - Phone:209-489-0056
Mailing Address - Fax:
Practice Address - Street 1:955 WAKE FOREST CT
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2155
Practice Address - Country:US
Practice Address - Phone:209-489-0056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-05
Last Update Date:2015-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YP1600X
BCBA 1-14-9575103K00000X
CALEP3560103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst