Provider Demographics
NPI:1568719862
Name:DAWSON, WENDY SUE (MA,LLP,)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:SUE
Last Name:DAWSON
Suffix:
Gender:F
Credentials:MA,LLP,
Other - Prefix:MS
Other - First Name:WENDY
Other - Middle Name:DAWSON
Other - Last Name:POMPOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LLP
Mailing Address - Street 1:13101 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2216
Mailing Address - Country:US
Mailing Address - Phone:734-785-7705
Mailing Address - Fax:734-287-1680
Practice Address - Street 1:13101 ALLEN RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2216
Practice Address - Country:US
Practice Address - Phone:734-785-7705
Practice Address - Fax:734-287-1680
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009303103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical