Provider Demographics
NPI:1235755901
Name:BRISHKE, WENDY LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:LYNN
Last Name:BRISHKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 W TALAVI BLVD STE 180
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-1888
Mailing Address - Country:US
Mailing Address - Phone:623-687-2894
Mailing Address - Fax:
Practice Address - Street 1:5701 W TALAVI BLVD STE 180
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-1888
Practice Address - Country:US
Practice Address - Phone:623-687-2894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-182021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical