Provider Demographics
NPI:1952696981
Name:ROBERTS, WENDI LOU (LPC, CADC I)
Entity type:Individual
Prefix:
First Name:WENDI LOU
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LPC, CADC I
Other - Prefix:
Other - First Name:LOU
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, CADC I
Mailing Address - Street 1:PO BOX 22201
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-0416
Mailing Address - Country:US
Mailing Address - Phone:541-870-6068
Mailing Address - Fax:
Practice Address - Street 1:44 CLUB RD STE 200
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2460
Practice Address - Country:US
Practice Address - Phone:541-972-4190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2024-12-14
Deactivation Date:2012-10-05
Deactivation Code:
Reactivation Date:2014-01-15
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X
ORC7461101YP2500X
ORQMHPC00838101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR20-06-01OtherMHACBO CADC I
ORQMHPC00838Medicaid