MEDICARE: WENDY WUNSCH LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	149009005	IL
2	1041C0700X	Clinical Social Worker	149.009005	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	363045007	OTHER		TAX ID#

General Provider Information

NPI Number	:	1841201126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY WUNSCH LCSW

Provider Business Mailing Address
First Line	:	14274 N CHAPARRAL SAGE RD
Second Line	:
City	:	MARANA
State	:	AZ
Zip	:	85658-5143
Country	:	US
Telephone Number	:	847-946-3199
Fax Number	:

Provider Business Practice Location Address
First Line	:	3146 E FORT LOWELL RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-1670
Country	:	US
Telephone Number	:	847-946-3199
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	05/04/2026

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