Provider Demographics
NPI:1265664114
Name:RADAZ, WENDY D (SOCIAL WORKER)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:D
Last Name:RADAZ
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1701 LAKE LANSING RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3798
Mailing Address - Country:US
Mailing Address - Phone:517-485-0001
Mailing Address - Fax:
Practice Address - Street 1:317 E WARWICK DR
Practice Address - Street 2:SUITE B
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1085
Practice Address - Country:US
Practice Address - Phone:989-463-2779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010638441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical