Provider Demographics
NPI:1689092603
Name:CALDWELL, WENDY SUZANNE
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:SUZANNE
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 HORIZON DR
Mailing Address - Street 2:STE 225
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8700
Mailing Address - Country:US
Mailing Address - Phone:970-683-7107
Mailing Address - Fax:970-683-7167
Practice Address - Street 1:6916 HIGHWAY 82
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-9435
Practice Address - Country:US
Practice Address - Phone:970-945-2583
Practice Address - Fax:970-928-8852
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACB0007858101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)