Provider Demographics
NPI:1689256034
Name:EGGEN, WENDY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:EGGEN
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 1:1028 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-2910
Mailing Address - Country:US
Mailing Address - Phone:605-665-4606
Mailing Address - Fax:
Practice Address - Street 1:200 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-3017
Practice Address - Country:US
Practice Address - Phone:605-624-9148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health