Provider Demographics
NPI:1104366129
Name:ACKLEY, WENDY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:ACKLEY
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:P.O. BOX 133
Mailing Address - Street 2:
Mailing Address - City:MANCHAUG
Mailing Address - State:MA
Mailing Address - Zip Code:01526
Mailing Address - Country:US
Mailing Address - Phone:774-318-8842
Mailing Address - Fax:
Practice Address - Street 1:67 SCHOOL STREET
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501
Practice Address - Country:US
Practice Address - Phone:774-318-8842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA111634104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker