Provider Demographics
NPI:1578079794
Name:LEDEZMA, WENDY CHAVEZ
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:CHAVEZ
Last Name:LEDEZMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 S HARBOR BLVD STE 650
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-3756
Mailing Address - Country:US
Mailing Address - Phone:714-871-5646
Mailing Address - Fax:714-817-7368
Practice Address - Street 1:222 S HARBOR BLVD STE 650
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-3756
Practice Address - Country:US
Practice Address - Phone:714-871-5646
Practice Address - Fax:714-817-7368
Is Sole Proprietor?:No
Enumeration Date:2017-12-26
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA135407106H00000X
CA6403101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist