Provider Demographics
NPI:1821203449
Name:ANDERSON, WENDY LOU
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:LOU
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1479 E DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-1745
Mailing Address - Country:US
Mailing Address - Phone:520-560-9225
Mailing Address - Fax:
Practice Address - Street 1:18128 E SUNNYBROOK LN
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297
Practice Address - Country:US
Practice Address - Phone:520-560-9225
Practice Address - Fax:520-876-9823
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4542385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child