Provider Demographics
NPI:1922577303
Name:SCOTT, WENDY DEANNA (LLPC)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:DEANNA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11763 MEADOWS CIR
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-3186
Mailing Address - Country:US
Mailing Address - Phone:313-627-6770
Mailing Address - Fax:
Practice Address - Street 1:5555 CONNER ST STE 1038
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-3487
Practice Address - Country:US
Practice Address - Phone:313-308-0255
Practice Address - Fax:313-308-0270
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011820101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1821120445Medicaid