Provider Demographics
NPI:1184847923
Name:PHILLIPS, WENDY SUE BECKER (LCSW, SSW)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:SUE BECKER
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LCSW, SSW
Other - Prefix:MRS
Other - First Name:WENDY
Other - Middle Name:SUE
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW,SSW
Mailing Address - Street 1:909 N. SMILEY STREET
Mailing Address - Street 2:
Mailing Address - City:O'FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1231
Mailing Address - Country:US
Mailing Address - Phone:618-632-6541
Mailing Address - Fax:
Practice Address - Street 1:909 N. SMILEY STREET
Practice Address - Street 2:
Practice Address - City:O'FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1231
Practice Address - Country:US
Practice Address - Phone:618-632-6541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0028821041C0700X
ILWP32261106P1041C0700X
IL16213401041S0200X
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL100044415-62762-01OtherSTATE OF ILLINOIS HUMAN