Provider Demographics
NPI:1093904344
Name:ACOSTA, WENDY J (M ED)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:J
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 W GORDON AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-2969
Mailing Address - Country:US
Mailing Address - Phone:509-944-0959
Mailing Address - Fax:509-326-2005
Practice Address - Street 1:3913 N POST ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-1149
Practice Address - Country:US
Practice Address - Phone:509-944-0959
Practice Address - Fax:509-326-2005
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00049235101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health