Provider Demographics
NPI:1801996350
Name:HART, WENDY SUZANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:SUZANNE
Last Name:HART
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 S DOBSON RD
Mailing Address - Street 2:SUITE 1004
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6481
Mailing Address - Country:US
Mailing Address - Phone:480-775-8811
Mailing Address - Fax:480-775-8866
Practice Address - Street 1:2222 S DOBSON RD
Practice Address - Street 2:SUITE 1004
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6481
Practice Address - Country:US
Practice Address - Phone:480-775-8811
Practice Address - Fax:480-775-8866
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2039103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ103279Medicare PIN
AZQ44395Medicare UPIN