Provider Demographics
NPI:1720079379
Name:BOVELL, WENDY KILPATRICK (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:KILPATRICK
Last Name:BOVELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8533
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37414
Mailing Address - Country:US
Mailing Address - Phone:423-304-1075
Mailing Address - Fax:
Practice Address - Street 1:101 JORDAN DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-6732
Practice Address - Country:US
Practice Address - Phone:423-510-1999
Practice Address - Fax:423-510-1888
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
022634OtherVMC
TN3925616Medicaid
213933OtherCOMPSYCH
4045771OtherBCBS
TN3925616Medicaid