Provider Demographics
NPI:1871237552
Name:WENDT, JAIDE S (BS)
Entity Type:Individual
Prefix:
First Name:JAIDE
Middle Name:S
Last Name:WENDT
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 VAUXHALL ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-5711
Mailing Address - Country:US
Mailing Address - Phone:860-437-4550
Mailing Address - Fax:860-701-3776
Practice Address - Street 1:7 VAUXHALL ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-5711
Practice Address - Country:US
Practice Address - Phone:860-437-4550
Practice Address - Fax:860-701-3776
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist