Provider Demographics
NPI:1669579603
Name:CHANDROSS, WENDY (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:CHANDROSS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21001 N TATUM BLVD
Mailing Address - Street 2:SUITE 1630-190
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4206
Mailing Address - Country:US
Mailing Address - Phone:602-571-1978
Mailing Address - Fax:602-548-1446
Practice Address - Street 1:18205 N 51ST AVE BLDG 2
Practice Address - Street 2:STE 115
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1490
Practice Address - Country:US
Practice Address - Phone:602-571-1978
Practice Address - Fax:602-548-1446
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-109601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ944307Medicaid
Z136476Medicare PIN
AZZ136476Medicare PIN