Healthcare Provider Details

I. General information

NPI: 1639790611
Provider Name (Legal Business Name): WENDY ARMSTRONG BA, CADC, MHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WENDY OXFORD

II. Dates (important events)

Enumeration Date: 05/01/2020
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 E VINE ST
VIENNA IL
62995-1612
US

IV. Provider business mailing address

406 E VINE ST
VIENNA IL
62995-1612
US

V. Phone/Fax

Practice location:
  • Phone: 618-658-3079
  • Fax: 618-658-2759
Mailing address:
  • Phone: 618-658-3079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: