Healthcare Provider Details

I. General information

NPI: 1811035702
Provider Name (Legal Business Name): WENDY ZOLLA TREADWAY M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 GROVER SMITH RD
BAKER WV
26801-0058
US

IV. Provider business mailing address

PO BOX 58
BAKER WV
26801-0058
US

V. Phone/Fax

Practice location:
  • Phone: 304-897-6028
  • Fax: 304-897-7010
Mailing address:
  • Phone: 304-897-6028
  • Fax: 304-897-7010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number947
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: