Provider Demographics
NPI:1164166518
Name:BROUSSEAU-ANDERSON, WENDY SUE (LMFT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:SUE
Last Name:BROUSSEAU-ANDERSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4095
Mailing Address - Country:US
Mailing Address - Phone:808-280-8599
Mailing Address - Fax:
Practice Address - Street 1:515 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4095
Practice Address - Country:US
Practice Address - Phone:808-280-8599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI982-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist