Provider Demographics
NPI:1427233410
Name:WENDT, DIANE RENEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:RENEE
Last Name:WENDT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 34
Mailing Address - Street 2:
Mailing Address - City:PICKWICK DAM
Mailing Address - State:TN
Mailing Address - Zip Code:38365
Mailing Address - Country:US
Mailing Address - Phone:720-252-7985
Mailing Address - Fax:
Practice Address - Street 1:240 RIVERCLIFF LANE
Practice Address - Street 2:
Practice Address - City:COUNCE
Practice Address - State:TN
Practice Address - Zip Code:38326
Practice Address - Country:US
Practice Address - Phone:720-252-7985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO571041C0700X
TN57621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical