Provider Demographics
NPI:1245416726
Name:KLEIN, WENDY J
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:J
Last Name:KLEIN
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 1:4770 E ILIFF AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-6049
Mailing Address - Country:US
Mailing Address - Phone:303-204-0489
Mailing Address - Fax:303-757-7994
Practice Address - Street 1:4770 E ILIFF AVE STE 115
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6049
Practice Address - Country:US
Practice Address - Phone:303-204-0489
Practice Address - Fax:303-757-7994
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000015461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO90230337Medicaid