Provider Demographics
NPI:1396411229
Name:BUFFUM, WENDY M
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:M
Last Name:BUFFUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WINNEFRED ALY
Mailing Address - Street 2:
Mailing Address - City:LOPEZ ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98261-7927
Mailing Address - Country:US
Mailing Address - Phone:360-468-2097
Mailing Address - Fax:
Practice Address - Street 1:200 WINNEFRED ALY
Practice Address - Street 2:
Practice Address - City:LOPEZ ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98261-7927
Practice Address - Country:US
Practice Address - Phone:360-468-2097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61069329101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health