=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487509436
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WONDER WENDY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2026
-----------------------------------------------------
Last Update Date | 03/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6780 NW 163RD AVE
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97229-8269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-941-0181
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6780 NW 163RD AVE
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97229-8269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-941-0181
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER/OWNER
-----------------------------------------------------
Name | LISA MARIE RITTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 503-941-0181
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------