MEDICARE: ROBYN WENDELL, LCSW

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	1041C0700X	Clinical Social Worker	41137	TX

General Provider Information

NPI Number	:	1235581380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBYN WENDELL, LCSW

Provider Business Mailing Address
First Line	:	4425 S MO PAC EXPY
Second Line	:	SUITE 502
City	:	AUSTIN
State	:	TX
Zip	:	78735-6723
Country	:	US
Telephone Number	:	512-910-5279
Fax Number	:

Provider Business Practice Location Address
First Line	:	4425 S MO PAC EXPY
Second Line	:	SUITE 502
City	:	AUSTIN
State	:	TX
Zip	:	78735-6723
Country	:	US
Telephone Number	:	512-910-5279
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	MRS. ROBYN WENDELL
Credential	:	LCSW
Telephone Number	:	512-910-5279

Provider Enumeration Date	:	07/12/2016
Last Update Date	:	07/12/2016

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