Provider Demographics
NPI:1679871552
Name:FRASER DE AUGUSTINE, WENDY LYNN (MFT INTERN)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:LYNN
Last Name:FRASER DE AUGUSTINE
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11565 LAUREL CANYON
Mailing Address - Street 2:# 114
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345
Mailing Address - Country:US
Mailing Address - Phone:818-361-5030
Mailing Address - Fax:
Practice Address - Street 1:11565 LAUREL CANYON
Practice Address - Street 2:# 116
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345
Practice Address - Country:US
Practice Address - Phone:818-361-5030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner