Provider Demographics
NPI:1235494675
Name:MAYBURY, WENDY
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:
Last Name:MAYBURY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:WENDY
Other - Middle Name:L
Other - Last Name:SEIBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CADCI
Mailing Address - Street 1:6605 SE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-2161
Mailing Address - Country:US
Mailing Address - Phone:503-655-8401
Mailing Address - Fax:
Practice Address - Street 1:6605 SE LAKE RD
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-2161
Practice Address - Country:US
Practice Address - Phone:503-655-8401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health