Provider Demographics
NPI:1104960632
Name:THOMPSON, WENDY (PHD)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 PEARL
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-4622
Mailing Address - Country:US
Mailing Address - Phone:734-358-0477
Mailing Address - Fax:734-436-0253
Practice Address - Street 1:1207 PEARL
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-4622
Practice Address - Country:US
Practice Address - Phone:734-358-0477
Practice Address - Fax:734-436-0253
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009144103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical