Provider Demographics
NPI:1568626901
Name:OTT, WENDY LYNNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:LYNNE
Last Name:OTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11351 ULMERTON RD
Mailing Address - Street 2:UNIT 31
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33778-1634
Mailing Address - Country:US
Mailing Address - Phone:727-639-1196
Mailing Address - Fax:727-588-7063
Practice Address - Street 1:11351 ULMERTON RD
Practice Address - Street 2:UNIT 31
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-1634
Practice Address - Country:US
Practice Address - Phone:727-639-1196
Practice Address - Fax:727-588-7063
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW6475104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker