Healthcare Provider Details

I. General information

NPI: 1841436490
Provider Name (Legal Business Name): WENDI LYNN HOAG LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4507
US

IV. Provider business mailing address

667 BANNOCK STREET
DENVER CO
80204
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-6000
  • Fax:
Mailing address:
  • Phone: 303-602-4260
  • Fax: 303-436-5157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701004501
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0013609
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: