Provider Demographics
NPI:1770843310
Name:CRUMP, WENDY JOY (RD)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:JOY
Last Name:CRUMP
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 VERDUGO BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1402
Mailing Address - Country:US
Mailing Address - Phone:626-893-7244
Mailing Address - Fax:818-790-2816
Practice Address - Street 1:1809 VERDUGO BLVD STE 200
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1402
Practice Address - Country:US
Practice Address - Phone:626-893-7244
Practice Address - Fax:818-790-2816
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA819889133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered