Provider Demographics
NPI:1982325437
Name:WENDENBURG, HEIDI RACHEL
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:RACHEL
Last Name:WENDENBURG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2337 ANTELOPE LN
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-6594
Mailing Address - Country:US
Mailing Address - Phone:128-173-1895
Mailing Address - Fax:
Practice Address - Street 1:2337 ANTELOPE LN
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6594
Practice Address - Country:US
Practice Address - Phone:281-731-8957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84401101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional