Provider Demographics
NPI:1982741534
Name:SALAZAR, WENDY JAN (MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:JAN
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7055 CHARMANT DR APT 92
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-4337
Mailing Address - Country:US
Mailing Address - Phone:858-401-0722
Mailing Address - Fax:619-298-7267
Practice Address - Street 1:4153 1ST AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2047
Practice Address - Country:US
Practice Address - Phone:858-401-0722
Practice Address - Fax:619-298-7267
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC47937106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist