Provider Demographics
NPI:1073913174
Name:PERSSON, WENDY (IMFT, LSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:PERSSON
Suffix:
Gender:F
Credentials:IMFT, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 WINDHAM CT
Mailing Address - Street 2:SUITE #6
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5060
Mailing Address - Country:US
Mailing Address - Phone:330-726-6785
Mailing Address - Fax:330-726-6785
Practice Address - Street 1:940 WINDHAM CT
Practice Address - Street 2:SUITE #6
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-5060
Practice Address - Country:US
Practice Address - Phone:330-726-6785
Practice Address - Fax:330-726-6785
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000406101YP2500X
OHS001783104100000X
OHF1400014106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker