Provider Demographics
NPI:1104392448
Name:LADER, WENDY JANE
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:JANE
Last Name:LADER
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 1:2775 NW 49TH AVE # 205-143
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34482-6212
Mailing Address - Country:US
Mailing Address - Phone:773-480-2797
Mailing Address - Fax:
Practice Address - Street 1:3002 SE 1ST AVE STE 100
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0407
Practice Address - Country:US
Practice Address - Phone:352-251-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-14
Last Update Date:2018-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9666103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical