Provider Demographics
NPI:1376763755
Name:SLAYDEN, WENDY WORTH (MS MFTI)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:WORTH
Last Name:SLAYDEN
Suffix:
Gender:F
Credentials:MS MFTI
Other - Prefix:MS
Other - First Name:WENDY
Other - Middle Name:LOUISE
Other - Last Name:WORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1317 CASHEW RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1542
Mailing Address - Country:US
Mailing Address - Phone:707-272-3048
Mailing Address - Fax:707-535-0941
Practice Address - Street 1:1317 CASHEW RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1542
Practice Address - Country:US
Practice Address - Phone:707-272-3048
Practice Address - Fax:707-535-0941
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CAIMF56326101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IMF56326OtherCA