Provider Demographics
NPI:1245410257
Name:WENDY CHANDROSS CISW PC
Entity Type:Organization
Organization Name:WENDY CHANDROSS CISW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDROSS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:602-571-1978
Mailing Address - Street 1:21001 N TATUM BLVD
Mailing Address - Street 2:SUITE 1630-190
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4206
Mailing Address - Country:US
Mailing Address - Phone:602-571-1978
Mailing Address - Fax:602-548-1446
Practice Address - Street 1:18205 N 51ST AVE
Practice Address - Street 2:BUILDING 2, SUITE 115
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1490
Practice Address - Country:US
Practice Address - Phone:602-571-1978
Practice Address - Fax:602-548-1446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ109601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ944307Medicaid
AZZ136475Medicare PIN
AZ944307Medicaid