Provider Demographics
NPI:1356491617
Name:MYERS-CROMWELL, WENDY NICOLE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:NICOLE
Last Name:MYERS-CROMWELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1063 TREVOR PL
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-3809
Mailing Address - Country:US
Mailing Address - Phone:313-971-7822
Mailing Address - Fax:
Practice Address - Street 1:19855 OUTER DR STE 104W
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2027
Practice Address - Country:US
Practice Address - Phone:313-971-7822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010816691041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool