Provider Demographics
NPI:1821438730
Name:WENDT, JAYMI LYNN (LISW)
Entity Type:Individual
Prefix:MRS
First Name:JAYMI
Middle Name:LYNN
Last Name:WENDT
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:JAMELL
Other - Middle Name:LYNN
Other - Last Name:WENDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7880 HITCHCOCK RD
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5842
Mailing Address - Country:US
Mailing Address - Phone:330-540-4504
Mailing Address - Fax:330-797-9931
Practice Address - Street 1:4030 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9505
Practice Address - Country:US
Practice Address - Phone:330-286-0050
Practice Address - Fax:330-286-0055
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.13024181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical