Provider Demographics
NPI:1982961884
Name:WEND, ELEANOR E (LAC)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:E
Last Name:WEND
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 N 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-2550
Mailing Address - Country:US
Mailing Address - Phone:406-586-5493
Mailing Address - Fax:406-587-1238
Practice Address - Street 1:2310 N 7TH AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-2550
Practice Address - Country:US
Practice Address - Phone:406-586-5493
Practice Address - Fax:406-587-1238
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1369261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder