Provider Demographics
NPI:1780860296
Name:KEPFORD, WENDY KAY (LISW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:KAY
Last Name:KEPFORD
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:KAY
Other - Last Name:BIRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 10TH ST SW
Mailing Address - Street 2:PO BOX 114
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-2925
Mailing Address - Country:US
Mailing Address - Phone:319-352-2064
Mailing Address - Fax:319-352-2329
Practice Address - Street 1:111 10TH ST SW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2925
Practice Address - Country:US
Practice Address - Phone:319-352-2064
Practice Address - Fax:319-352-2329
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02610101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA02610OtherLISW