Provider Demographics
NPI:1922554815
Name:PHILLIP, WENDYANN E
Entity Type:Individual
Prefix:
First Name:WENDYANN
Middle Name:E
Last Name:PHILLIP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WENDYANN
Other - Middle Name:E
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:07/29/2016
Mailing Address - Street 1:1322 PARKWAY CT
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33413-3076
Mailing Address - Country:US
Mailing Address - Phone:561-563-1951
Mailing Address - Fax:
Practice Address - Street 1:1322 PARKWAY CT
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33413-3076
Practice Address - Country:US
Practice Address - Phone:561-563-1951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst