Provider Demographics
NPI:1659582427
Name:YOUNG, WENDY (LMSW, BCD)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LMSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N BEECHER ST
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:MI
Mailing Address - Zip Code:49911-1109
Mailing Address - Country:US
Mailing Address - Phone:906-663-4599
Mailing Address - Fax:906-663-4588
Practice Address - Street 1:101 N BEECHER ST
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:MI
Practice Address - Zip Code:49911-1109
Practice Address - Country:US
Practice Address - Phone:906-663-4599
Practice Address - Fax:906-663-4588
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010805691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008900330OtherBCBS PIN