Provider Demographics
NPI:1306179395
Name:MYERS, WENDY SUE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:SUE
Last Name:MYERS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 E 32ND ST STE 11
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-2969
Mailing Address - Country:US
Mailing Address - Phone:417-439-3334
Mailing Address - Fax:
Practice Address - Street 1:1329 E 32ND ST STE 11
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2969
Practice Address - Country:US
Practice Address - Phone:417-439-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7975104100000X
MO20110229071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker