Provider Demographics
NPI:1740426675
Name:ABBOTT, WENDY ANN (NYS LMT)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:ANN
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:NYS LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 AVIATION RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-8402
Mailing Address - Country:US
Mailing Address - Phone:518-338-6331
Mailing Address - Fax:
Practice Address - Street 1:8 AVIATION RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-8402
Practice Address - Country:US
Practice Address - Phone:518-338-6331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-24
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022184172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker