Provider Demographics
NPI:1700224037
Name:DAN, WENDY LEE
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:LEE
Last Name:DAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:WENDY
Other - Middle Name:DAN
Other - Last Name:SCHLOSSBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4545 ARIZONA ST
Mailing Address - Street 2:#106
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-2931
Mailing Address - Country:US
Mailing Address - Phone:619-884-4441
Mailing Address - Fax:
Practice Address - Street 1:2204 NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113-3615
Practice Address - Country:US
Practice Address - Phone:619-515-2355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA260151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical