Provider Demographics
NPI:1790557585
Name:STEPHANIE WENDLAND LPC PLLC
Entity Type:Organization
Organization Name:STEPHANIE WENDLAND LPC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WENDLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-362-4359
Mailing Address - Street 1:4454 E TIMBERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3838
Mailing Address - Country:US
Mailing Address - Phone:630-362-4359
Mailing Address - Fax:
Practice Address - Street 1:810 COTTAGEVIEW DR STE 102
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2392
Practice Address - Country:US
Practice Address - Phone:630-362-4359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty