Healthcare Provider Details

I. General information

NPI: 1548417546
Provider Name (Legal Business Name): WENDY MARIE ELLIOTT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W CIVIC CENTER DR STE 500
SANTA ANA CA
92701-4515
US

IV. Provider business mailing address

401 W CIVIC CENTER DR STE 500
SANTA ANA CA
92701-4515
US

V. Phone/Fax

Practice location:
  • Phone: 714-480-6660
  • Fax:
Mailing address:
  • Phone: 714-480-6723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW 22808
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW 27941
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: