Provider Demographics
NPI:1356312391
Name:WEDGE, MARILYN (MS, PHD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:
Last Name:WEDGE
Suffix:
Gender:F
Credentials:MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6591 MAPLEGROVE ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91377-1313
Mailing Address - Country:US
Mailing Address - Phone:818-735-9709
Mailing Address - Fax:818-735-9709
Practice Address - Street 1:141 DUESENBERG DR
Practice Address - Street 2:SUITE 9
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3416
Practice Address - Country:US
Practice Address - Phone:818-735-9709
Practice Address - Fax:818-735-9709
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC23729106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist