Provider Demographics
NPI:1700410578
Name:BERTRAM, WENDY M (LCSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:M
Last Name:BERTRAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:M
Other - Last Name:STUFFLEBEAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:428 S GILBERT RD STE 105
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-2261
Mailing Address - Country:US
Mailing Address - Phone:480-297-3429
Mailing Address - Fax:
Practice Address - Street 1:428 S GILBERT RD STE 105
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-2261
Practice Address - Country:US
Practice Address - Phone:480-297-3429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-181991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical