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NPI Code Detail

MEDICARE: DR. LAURA MARIE WENDLANDT PH.D.

MEDICARE: DR. LAURA MARIE WENDLANDT 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
1103T00000XPsychologistPY0401NV
2103T00000XPsychologist382MT
3103T00000XPsychologist
4103TH0100XHealth Service Psychologist
5103TC0700XClinical PsychologistPSY-004631AZ

General Provider Information

NPI Number : 1558591172
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAURA MARIE WENDLANDT PH.D.
Provider Business Mailing Address
First Line : 40438 N KENNEDY DR
Second Line :
City : SAN TAN VALLEY
State : AZ
Zip : 85140-9866
Country : US
Telephone Number : 406-697-1040
Fax Number :
Provider Business Practice Location Address
First Line : 5859 W TALAVI BLVD STE 180
Second Line :
City : GLENDALE
State : AZ
Zip : 85306-1873
Country : US
Telephone Number : 602-560-2836
Fax Number : 317-520-8200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2009
Last Update Date : 08/13/2020

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