Provider Demographics
NPI:1154443323
Name:REBENTISCH, WENDY (MS, LPHA WAIVED)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:
Last Name:REBENTISCH
Suffix:
Gender:F
Credentials:MS, LPHA WAIVED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 AUBURN BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-2005
Mailing Address - Country:US
Mailing Address - Phone:916-482-2370
Mailing Address - Fax:916-480-6241
Practice Address - Street 1:3555 AUBURN BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-2005
Practice Address - Country:US
Practice Address - Phone:916-482-2370
Practice Address - Fax:916-480-6241
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW287741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical