Provider Demographics
NPI:1184659955
Name:NILSEN, WENDY JEAN (PHD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:JEAN
Last Name:NILSEN
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:PSYCHIATRIC CLINICAL GROUP
Mailing Address - Street 2:300 CRITTENDEN BLVD
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-6733
Mailing Address - Fax:
Practice Address - Street 1:PSYCHIATRIC CLINICAL GROUP
Practice Address - Street 2:300 CRITTENDEN BLVD
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-6733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP50681106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP50681OtherNYS LIMITED PERMIT