Provider Demographics
NPI:1154995124
Name:BERTRAM, WENDY ANNE (LMHC)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:ANNE
Last Name:BERTRAM
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 212TH ST SW
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-7538
Mailing Address - Country:US
Mailing Address - Phone:206-430-9234
Mailing Address - Fax:
Practice Address - Street 1:131 3RD AVE N
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3208
Practice Address - Country:US
Practice Address - Phone:206-430-9234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61048852101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH61048852OtherLICENSE