Provider Demographics
NPI:1922776889
Name:MIKOLICH, WENDY S (LSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:S
Last Name:MIKOLICH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:S
Other - Last Name:WHERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:2517 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-1424
Mailing Address - Country:US
Mailing Address - Phone:814-241-7990
Mailing Address - Fax:
Practice Address - Street 1:2517 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-1424
Practice Address - Country:US
Practice Address - Phone:814-241-7990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW134277104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker