Provider Demographics
NPI:1639937766
Name:PELLETIER, WENDY K (BA)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:K
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 NW CARRIE CIR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647-5672
Mailing Address - Country:US
Mailing Address - Phone:208-598-5387
Mailing Address - Fax:
Practice Address - Street 1:1140 AMERICAN LEGION BLVD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-2821
Practice Address - Country:US
Practice Address - Phone:208-598-5387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator