Healthcare Provider Details

I. General information

NPI: 1558708222
Provider Name (Legal Business Name): WENDY ANN DUDEK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 S KIRKWOOD RD
KIRKWOOD MO
63122-4015
US

IV. Provider business mailing address

343 SOUTH KIRKWOOD ROAD
KIRKWOOD MO
63122
US

V. Phone/Fax

Practice location:
  • Phone: 314-729-4004
  • Fax: 314-729-4002
Mailing address:
  • Phone: 314-729-4004
  • Fax: 314-729-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2010019060
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: