Provider Demographics
NPI:1073079364
Name:SIMPSON, WENDY R (SWLC, LAC)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:R
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:SWLC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 HARRISON AVE STE 247
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-6044
Mailing Address - Country:US
Mailing Address - Phone:406-624-9744
Mailing Address - Fax:
Practice Address - Street 1:65 E BROADWAY ST STE 102
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-9305
Practice Address - Country:US
Practice Address - Phone:406-624-9744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-SWLC-LIC-350481041C0700X
MTBBH-LAC-LIC-37005101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTBBH-LAC-LIC-37005OtherLICENSE
MTBBH-SWLC-LIC-35048OtherLICENSE