Provider Demographics
NPI:1528389210
Name:WENDEL, ALISON (MT-BC)
Entity Type:Individual
Prefix:MS
First Name:ALISON
Middle Name:
Last Name:WENDEL
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1547 EAGLEMANN CT
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-3410
Mailing Address - Country:US
Mailing Address - Phone:801-913-0018
Mailing Address - Fax:801-255-1557
Practice Address - Street 1:1547 EAGLEMANN CT
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-3410
Practice Address - Country:US
Practice Address - Phone:801-913-0018
Practice Address - Fax:801-255-1557
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04946174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist