Provider Demographics
NPI:1629084355
Name:ANDORF-BLUM, WENDY L (LCSW LIMHP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:L
Last Name:ANDORF-BLUM
Suffix:
Gender:F
Credentials:LCSW LIMHP
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:L
Other - Last Name:ANDORF-BLUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4444 SOUTH 86TH ST
Mailing Address - Street 2:STE 102
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9253
Mailing Address - Country:US
Mailing Address - Phone:402-476-7557
Mailing Address - Fax:402-476-9912
Practice Address - Street 1:4444 SOUTH 86TH ST
Practice Address - Street 2:STE 102
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9253
Practice Address - Country:US
Practice Address - Phone:402-476-7557
Practice Address - Fax:402-476-9912
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3201041C0700X
NE81041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025262900Medicaid
NE247270000OtherMAGELLAN
NE85345OtherBCBS
NE247270000OtherMAGELLAN