Provider Demographics
NPI:1235612318
Name:RISKO, WENDY MILLER
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:MILLER
Last Name:RISKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 KATHERINE LEE BATES RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2897
Mailing Address - Country:US
Mailing Address - Phone:508-548-0220
Mailing Address - Fax:508-457-5404
Practice Address - Street 1:130 KATHERINE LEE BATES RD
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2897
Practice Address - Country:US
Practice Address - Phone:508-548-0220
Practice Address - Fax:508-457-5404
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1101981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical