Healthcare Provider Details

I. General information

NPI: 1922776889
Provider Name (Legal Business Name): WENDY S MIKOLICH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WENDY S WHERRY LSW

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2517 BEDFORD ST
JOHNSTOWN PA
15904-1424
US

IV. Provider business mailing address

2517 BEDFORD ST
JOHNSTOWN PA
15904-1424
US

V. Phone/Fax

Practice location:
  • Phone: 814-241-7990
  • Fax:
Mailing address:
  • Phone: 814-241-7990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW027131
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW134277
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: