Provider Demographics
NPI:1619752086
Name:ROMAN VALLADARES, WENDY MARGARITA (MS)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:MARGARITA
Last Name:ROMAN VALLADARES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3448 W 72ND ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-3506
Mailing Address - Country:US
Mailing Address - Phone:773-698-3570
Mailing Address - Fax:
Practice Address - Street 1:3448 W 72ND ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-3506
Practice Address - Country:US
Practice Address - Phone:773-698-3570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health