Provider Demographics
NPI:1619438074
Name:VANDERWATER, WENDIE J (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:WENDIE
Middle Name:J
Last Name:VANDERWATER
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 1:2918 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-6643
Mailing Address - Country:US
Mailing Address - Phone:406-461-8820
Mailing Address - Fax:406-225-3464
Practice Address - Street 1:110 VENTURE WAY
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:MT
Practice Address - Zip Code:59632
Practice Address - Country:US
Practice Address - Phone:406-225-4605
Practice Address - Fax:406-225-3464
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT323991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical