Provider Demographics
NPI:1942792825
Name:LEON-JOHNSON, WENDY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:LEON-JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15442 AVENIDA MIROLA
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-7087
Mailing Address - Country:US
Mailing Address - Phone:760-574-7556
Mailing Address - Fax:
Practice Address - Street 1:490 S FARRELL DR STE C208
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7944
Practice Address - Country:US
Practice Address - Phone:760-325-4088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty