Provider Demographics
NPI:1558591172
Name:WENDLANDT, LAURA MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MARIE
Last Name:WENDLANDT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40438 N KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-9866
Mailing Address - Country:US
Mailing Address - Phone:406-697-1040
Mailing Address - Fax:
Practice Address - Street 1:5859 W TALAVI BLVD STE 180
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-1873
Practice Address - Country:US
Practice Address - Phone:602-560-2836
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0401103T00000X
MT382103T00000X
103T00000X, 103TH0100X
AZPSY-004631103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service