Provider Demographics
NPI:1689610040
Name:WENDT, AUDREY ANN (MSW, LMSW, CAADC)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:ANN
Last Name:WENDT
Suffix:
Gender:F
Credentials:MSW, LMSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1382 E HULL RD
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:MI
Mailing Address - Zip Code:48628-9767
Mailing Address - Country:US
Mailing Address - Phone:989-689-4052
Mailing Address - Fax:989-689-5016
Practice Address - Street 1:122 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:MI
Practice Address - Zip Code:48847-1024
Practice Address - Country:US
Practice Address - Phone:989-388-4185
Practice Address - Fax:989-388-4187
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802080890104100000X
MI2-00817101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker