Provider Demographics
NPI:1083868491
Name:KOEBEL, WENDY L (LMSW ACSW)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:L
Last Name:KOEBEL
Suffix:
Gender:F
Credentials:LMSW ACSW
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:L
Other - Last Name:GREENWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW ACSW
Mailing Address - Street 1:2430 YASMIN DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-5202
Mailing Address - Country:US
Mailing Address - Phone:248-321-1953
Mailing Address - Fax:
Practice Address - Street 1:5640 W MAPLE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3716
Practice Address - Country:US
Practice Address - Phone:248-321-1953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68020747421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical