Provider Demographics
NPI:1841201126
Name:WUNSCH, WENDY (LCSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:WUNSCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 OLDE HALF DAY RD STE 140-8
Mailing Address - Street 2:
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-3089
Mailing Address - Country:US
Mailing Address - Phone:847-946-3199
Mailing Address - Fax:
Practice Address - Street 1:175 OLDE HALF DAY RD STE 140-8
Practice Address - Street 2:
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-3089
Practice Address - Country:US
Practice Address - Phone:847-946-3199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0090051041C0700X
IL149009005104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
363045007OtherTAX ID#
363045007OtherTAX ID#
363045007OtherTAX ID#
ILK17996Medicare PIN