Provider Demographics
NPI:1922217694
Name:DILLENDER, WENDY (MSW)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:
Last Name:DILLENDER
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 1:909 MISSOURI BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-1771
Mailing Address - Country:US
Mailing Address - Phone:573-584-0158
Mailing Address - Fax:573-584-0159
Practice Address - Street 1:909 MISSOURI BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-1771
Practice Address - Country:US
Practice Address - Phone:573-584-0158
Practice Address - Fax:573-584-0159
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010310221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical