Provider Demographics
NPI:1073052908
Name:PETHYBRIDGE, WENDY (MA, MS)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:PETHYBRIDGE
Suffix:
Gender:F
Credentials:MA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 N PEBBLE CREEK PKWY APT 2127
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-9037
Mailing Address - Country:US
Mailing Address - Phone:253-257-5177
Mailing Address - Fax:315-546-2406
Practice Address - Street 1:4200 N PEBBLE CREEK PKWY APT 2127
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-9037
Practice Address - Country:US
Practice Address - Phone:253-257-5177
Practice Address - Fax:315-546-2406
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-12
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2176663Medicaid