Healthcare Provider Details

I. General information

NPI: 1538276837
Provider Name (Legal Business Name): WENDY BECKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 EDWARDSVILLE RD UNIT 90
TROY IL
62294-7003
US

IV. Provider business mailing address

515 EDWARDSVILLE RD UNIT 90
TROY IL
62294-7003
US

V. Phone/Fax

Practice location:
  • Phone: 253-432-8389
  • Fax:
Mailing address:
  • Phone: 970-231-3583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60838444
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.027868
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: