Provider Demographics
NPI:1922165463
Name:DORMONT, WENDY S (MA)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:S
Last Name:DORMONT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UW CAMPUS
Practice Address - Street 2:EAST STEVENS CIRCLE
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-4410
Practice Address - Country:US
Practice Address - Phone:206-616-2495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH0000537101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000368OtherINTERNAL ID-MOTOR VEHICLE ID