Provider Demographics
NPI:1356786057
Name:KRALL-TIBALDO, WENDY SUZANNE (LMSW)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:SUZANNE
Last Name:KRALL-TIBALDO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:SUZANNE
Other - Last Name:STEIGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 W US HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49968-9515
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 W US HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MI
Practice Address - Zip Code:49968
Practice Address - Country:US
Practice Address - Phone:906-229-6120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010948421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical