Provider Demographics
NPI:1780663138
Name:WENDTLAND, LEIGH PAVA (PHD LLP)
Entity Type:Individual
Prefix:DR
First Name:LEIGH
Middle Name:PAVA
Last Name:WENDTLAND
Suffix:
Gender:F
Credentials:PHD LLP
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:WENDTLAND
Other - Last Name:O'CONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2401 CAMELOT CT SE STE E
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6083
Mailing Address - Country:US
Mailing Address - Phone:616-648-2289
Mailing Address - Fax:616-949-3018
Practice Address - Street 1:2401 CAMELOT CT SE STE E
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6083
Practice Address - Country:US
Practice Address - Phone:616-648-2289
Practice Address - Fax:616-949-3018
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2023-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012338103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical