MEDICARE: MADDIE WENDLER

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1851824924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADDIE WENDLER

Provider Business Mailing Address
First Line	:	1035 VIRGINIA DRIVE
Second Line	:
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034
Country	:	US
Telephone Number	:	877-636-9322
Fax Number	:

Provider Business Practice Location Address
First Line	:	1035 VIRGINIA DR
Second Line	:
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-3103
Country	:	US
Telephone Number	:	877-636-9322
Fax Number	:

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

Provider Enumeration Date	:	04/06/2017
Last Update Date	:	04/06/2017

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Directions to “ MADDIE WENDLER ” Practice Location

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