Provider Demographics
NPI:1629005202
Name:WENDT, ROBERT NASH (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:NASH
Last Name:WENDT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3432 COREY RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1651
Mailing Address - Country:US
Mailing Address - Phone:419-843-5358
Mailing Address - Fax:419-534-2397
Practice Address - Street 1:3454 OAK ALLEY CT
Practice Address - Street 2:SUITE 305
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1306
Practice Address - Country:US
Practice Address - Phone:419-534-2468
Practice Address - Fax:419-534-2397
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2297103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0407910Medicaid
OH0407910Medicaid