Provider Demographics
NPI:1720400070
Name:NATHAN, WENDY (PCC-S)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:
Last Name:NATHAN
Suffix:
Gender:F
Credentials:PCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 AUDUBON PL
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3301
Mailing Address - Country:US
Mailing Address - Phone:419-531-5390
Mailing Address - Fax:
Practice Address - Street 1:2114 AUDUBON PL
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3301
Practice Address - Country:US
Practice Address - Phone:419-531-5390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC4949101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional