Healthcare Provider Details

I. General information

NPI: 1093883704
Provider Name (Legal Business Name): WENDY JO WESTERMAN BA, MHPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS WENDY JO KNUDTSON

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W SECOND ST
LONOKE AR
72086
US

IV. Provider business mailing address

650 S SHACKLEFORD RD SUITE 217
LITTLE ROCK AR
72211-3522
US

V. Phone/Fax

Practice location:
  • Phone: 501-676-5968
  • Fax: 501-676-3152
Mailing address:
  • Phone: 501-221-1843
  • Fax: 501-221-2376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: