Provider Demographics
NPI:1255485371
Name:WHITAKER, WENDY (MSW, CSW, CATC)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:MSW, CSW, CATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 ABBEY RD
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-7805
Mailing Address - Country:US
Mailing Address - Phone:605-224-8841
Mailing Address - Fax:605-224-6852
Practice Address - Street 1:1714 ABBEY RD
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-7805
Practice Address - Country:US
Practice Address - Phone:605-224-8841
Practice Address - Fax:605-224-6852
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4251101YA0400X
CA020580101YA0400X
SD21561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5350180Medicaid