Provider Demographics
NPI:1720210354
Name:HASKELL, WENDY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:HASKELL
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 1:129 WEST RD
Mailing Address - Street 2:
Mailing Address - City:BEACON FALLS
Mailing Address - State:CT
Mailing Address - Zip Code:06403-1533
Mailing Address - Country:US
Mailing Address - Phone:203-598-4351
Mailing Address - Fax:203-881-1255
Practice Address - Street 1:129 WEST RD
Practice Address - Street 2:
Practice Address - City:BEACON FALLS
Practice Address - State:CT
Practice Address - Zip Code:06403-1533
Practice Address - Country:US
Practice Address - Phone:203-598-4351
Practice Address - Fax:203-881-1255
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-15
Last Update Date:2009-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000474171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist