Provider Demographics
NPI:1780281725
Name:WENDT, FREDERICK SCOTT (MSW, APSW)
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:SCOTT
Last Name:WENDT
Suffix:
Gender:M
Credentials:MSW, APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6522 N SUNNY POINT RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4079
Mailing Address - Country:US
Mailing Address - Phone:608-622-0790
Mailing Address - Fax:
Practice Address - Street 1:2524 E WEBSTER PL
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4256
Practice Address - Country:US
Practice Address - Phone:414-964-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI131964-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI131964-121OtherWI DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES