Provider Demographics
NPI:1851727721
Name:JAMROG, WENDY LOU (MSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:LOU
Last Name:JAMROG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12062 BOLDREY DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-9653
Mailing Address - Country:US
Mailing Address - Phone:810-444-9574
Mailing Address - Fax:
Practice Address - Street 1:12062 BOLDREY DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-9653
Practice Address - Country:US
Practice Address - Phone:810-444-9574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802070557104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker