Healthcare Provider Details

I. General information

NPI: 1467362012
Provider Name (Legal Business Name): MADISON WENDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44001 GARFIELD RD
CLINTON TWP MI
48038-1100
US

IV. Provider business mailing address

25304 SAMANTHA DR
CHESTERFIELD MI
48051-1968
US

V. Phone/Fax

Practice location:
  • Phone: 586-995-1693
  • Fax:
Mailing address:
  • Phone: 586-995-1693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: