Provider Demographics
NPI:1184105397
Name:WENDT, MICHELLE L (DACM)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:L
Last Name:WENDT
Suffix:
Gender:F
Credentials:DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14141 W HWY 290 STE 510
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-9329
Mailing Address - Country:US
Mailing Address - Phone:512-686-0777
Mailing Address - Fax:
Practice Address - Street 1:14141 W HWY 290 STE 510
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737-9329
Practice Address - Country:US
Practice Address - Phone:512-686-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-25
Last Update Date:2018-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01738171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist