MEDICARE: WENDY BERTGES YOST PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	6301011796	MI

General Provider Information

NPI Number	:	1235337866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY BERTGES YOST PH.D.

Provider Business Mailing Address
First Line	:	22146 BEECHWOOD AVE
Second Line	:
City	:	EASTPOINTE
State	:	MI
Zip	:	48021-3816
Country	:	US
Telephone Number	:	586-778-6631
Fax Number	:

Provider Business Practice Location Address
First Line	:	42633 GARFIELD RD
Second Line	:	SUITE 314
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-5033
Country	:	US
Telephone Number	:	586-226-7007
Fax Number	:	586-226-7033

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	07/08/2007

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