Provider Demographics
NPI:1619046570
Name:TRAVIS, WENDY JEAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:JEAN
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:WENDY
Other - Middle Name:JEAN
Other - Last Name:WYSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:78 MEDICAL OPERATIONS SQUADRON
Mailing Address - Street 2:SGOH
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31098
Mailing Address - Country:US
Mailing Address - Phone:478-327-8436
Mailing Address - Fax:
Practice Address - Street 1:78 MEDICAL OPERATIONS SQUADRON
Practice Address - Street 2:SGOH
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31098
Practice Address - Country:US
Practice Address - Phone:478-327-8436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical