MEDICARE: MRS. 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	:	1790182657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROBYN WENDELL LCSW

Provider Business Mailing Address
First Line	:	5704 LOMITA VERDE CIR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-4201
Country	:	US
Telephone Number	:	512-910-5279
Fax Number	:	512-640-5771

Provider Business Practice Location Address
First Line	:	5704 LOMITA VERDE CIR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-4201
Country	:	US
Telephone Number	:	512-910-5279
Fax Number	:	512-640-5771

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

Provider Enumeration Date	:	11/20/2014
Last Update Date	:	09/17/2020

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