Provider Demographics
NPI:1962650986
Name:ESSENBURG, WENDY (PHD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:ESSENBURG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 WALTON BLVD
Mailing Address - Street 2:SUITE 218
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1768
Mailing Address - Country:US
Mailing Address - Phone:248-568-3125
Mailing Address - Fax:248-608-6088
Practice Address - Street 1:1460 WALTON BLVD
Practice Address - Street 2:SUITE 218
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1768
Practice Address - Country:US
Practice Address - Phone:248-568-3125
Practice Address - Fax:248-608-6088
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012902103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical