Provider Demographics
NPI:1477930642
Name:LINDGREN, WENDY (LMT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:LINDGREN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29540 SOUTHFIELD RD
Mailing Address - Street 2:STE 100
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2047
Mailing Address - Country:US
Mailing Address - Phone:248-917-1864
Mailing Address - Fax:
Practice Address - Street 1:29540 SOUTHFIELD RD
Practice Address - Street 2:STE 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2047
Practice Address - Country:US
Practice Address - Phone:248-917-1864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL164348225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist