Provider Demographics
NPI:1407177728
Name:FAHLGREN, WENDY CHRISTINE (LMSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:CHRISTINE
Last Name:FAHLGREN
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 1:1009 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-2108
Mailing Address - Country:US
Mailing Address - Phone:641-683-4300
Mailing Address - Fax:
Practice Address - Street 1:1009 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2108
Practice Address - Country:US
Practice Address - Phone:641-683-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2011-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007528104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker