Provider Demographics
NPI:1336304484
Name:ELZINGA, WENDY SUE (LLP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:SUE
Last Name:ELZINGA
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:SUE
Other - Last Name:LAPHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLP
Mailing Address - Street 1:509 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1400
Mailing Address - Country:US
Mailing Address - Phone:616-510-6650
Mailing Address - Fax:
Practice Address - Street 1:509 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1400
Practice Address - Country:US
Practice Address - Phone:616-510-6650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013611103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling