Provider Demographics
NPI:1467738450
Name:CRABTREE, WENDI J
Entity Type:Individual
Prefix:
First Name:WENDI
Middle Name:J
Last Name:CRABTREE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WENDI
Other - Middle Name:J
Other - Last Name:WEIDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 DEVONSHIRE DR
Mailing Address - Street 2:SUITE B15
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-7337
Mailing Address - Country:US
Mailing Address - Phone:217-352-0200
Mailing Address - Fax:217-352-0200
Practice Address - Street 1:701 DEVONSHIRE DR
Practice Address - Street 2:SUITE B15
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7337
Practice Address - Country:US
Practice Address - Phone:217-352-0200
Practice Address - Fax:217-352-0200
Is Sole Proprietor?:No
Enumeration Date:2011-10-23
Last Update Date:2011-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178005713101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional