Provider Demographics
NPI:1013675230
Name:SMITH, WENDY KAY (LSWAIC)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:KAY
Last Name:SMITH
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20228 134TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-8685
Mailing Address - Country:US
Mailing Address - Phone:425-772-7321
Mailing Address - Fax:
Practice Address - Street 1:13901 NE 175TH ST STE L
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-8548
Practice Address - Country:US
Practice Address - Phone:425-772-7321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-05
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC611539771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical