Provider Demographics
NPI:1093883704
Name:WESTERMAN, WENDY JO (BA, MHPP)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:JO
Last Name:WESTERMAN
Suffix:
Gender:F
Credentials:BA, MHPP
Other - Prefix:MISS
Other - First Name:WENDY
Other - Middle Name:JO
Other - Last Name:KNUDTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:650 S SHACKLEFORD RD
Mailing Address - Street 2:SUITE 217
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3522
Mailing Address - Country:US
Mailing Address - Phone:501-221-1843
Mailing Address - Fax:501-221-2376
Practice Address - Street 1:201 W SECOND ST
Practice Address - Street 2:
Practice Address - City:LONOKE
Practice Address - State:AR
Practice Address - Zip Code:72086
Practice Address - Country:US
Practice Address - Phone:501-676-5968
Practice Address - Fax:501-676-3152
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator