Provider Demographics
NPI:1558144477
Name:DANNER, WENDY JEAN (LCSW CCM)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:JEAN
Last Name:DANNER
Suffix:
Gender:F
Credentials:LCSW CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VA MEDICAL CENTER
Mailing Address - Street 2:4500 S LANCASTER RD
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216
Mailing Address - Country:US
Mailing Address - Phone:214-742-8387
Mailing Address - Fax:
Practice Address - Street 1:1207 HARREL ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4327
Practice Address - Country:US
Practice Address - Phone:303-815-6084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1085271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical