Provider Demographics
NPI:1891742185
Name:BORDELON, WENDY WILLIAMS (MSW, LCSW, BACS)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:WILLIAMS
Last Name:BORDELON
Suffix:
Gender:F
Credentials:MSW, LCSW, BACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1737 WATSON RD
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-9038
Mailing Address - Country:US
Mailing Address - Phone:318-640-8618
Mailing Address - Fax:
Practice Address - Street 1:7215 SHREVEPORT HWY
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-2725
Practice Address - Country:US
Practice Address - Phone:318-419-3132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2011-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA41501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty