Provider Demographics
NPI:1952477143
Name:ANDERSON, WENDE J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:WENDE
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N PALM AVE UNIT 33850
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-5034
Mailing Address - Country:US
Mailing Address - Phone:321-541-1250
Mailing Address - Fax:321-951-1928
Practice Address - Street 1:1825 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4711
Practice Address - Country:US
Practice Address - Phone:321-541-1250
Practice Address - Fax:321-951-1928
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2023-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7426103T00000X, 103TH0100X, 103TC0700X
VA0810007012103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service