Healthcare Provider Details

I. General information

NPI: 1174455802
Provider Name (Legal Business Name): MRS. WENDI JEAN ENGUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3226 SHERMAN ST
EAU CLAIRE WI
54701-6664
US

IV. Provider business mailing address

3226 SHERMAN ST
EAU CLAIRE WI
54701-6664
US

V. Phone/Fax

Practice location:
  • Phone: 715-271-5792
  • Fax:
Mailing address:
  • Phone: 715-271-5792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: