Provider Demographics
NPI:1952310286
Name:WEDELL, WENDY LYNN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:LYNN
Last Name:WEDELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:WEDELL-WALKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:227 WINDERMERE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-1543
Mailing Address - Country:US
Mailing Address - Phone:203-366-0750
Mailing Address - Fax:203-366-0750
Practice Address - Street 1:227 WINDERMERE ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-1543
Practice Address - Country:US
Practice Address - Phone:203-366-0750
Practice Address - Fax:203-366-0750
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0051321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical