Provider Demographics
NPI:1164662193
Name:EHRLICH, WENDY J (PHD,)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:J
Last Name:EHRLICH
Suffix:
Gender:F
Credentials:PHD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1335
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94011-1335
Mailing Address - Country:US
Mailing Address - Phone:650-533-4185
Mailing Address - Fax:650-685-0449
Practice Address - Street 1:2100 WEBSTER ST
Practice Address - Street 2:SUITE 320
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2373
Practice Address - Country:US
Practice Address - Phone:650-533-4185
Practice Address - Fax:415-474-9423
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17532103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist