Provider Demographics
NPI:1942466776
Name:WENDY MCDONALD PC
Entity Type:Organization
Organization Name:WENDY MCDONALD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:979-846-8600
Mailing Address - Street 1:115 ROYAL ST
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77801-4432
Mailing Address - Country:US
Mailing Address - Phone:979-846-8600
Mailing Address - Fax:979-260-8330
Practice Address - Street 1:115 ROYAL ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77801-4432
Practice Address - Country:US
Practice Address - Phone:979-846-8600
Practice Address - Fax:979-260-8330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154728301Medicaid
TXP72940Medicare UPIN
TX00662PMedicare PIN