Provider Demographics
NPI:1073960936
Name:TUNNESSEN, WENDY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:TUNNESSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:WALTERS
Mailing Address - State:OK
Mailing Address - Zip Code:73572-2862
Mailing Address - Country:US
Mailing Address - Phone:580-450-1129
Mailing Address - Fax:
Practice Address - Street 1:420 E WYOMING ST
Practice Address - Street 2:
Practice Address - City:WALTERS
Practice Address - State:OK
Practice Address - Zip Code:73572-2862
Practice Address - Country:US
Practice Address - Phone:580-450-1129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor