Provider Demographics
NPI:1194960260
Name:MARTIN, WENDY S
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:S
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MANITOU SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80829-2803
Mailing Address - Country:US
Mailing Address - Phone:719-201-2468
Mailing Address - Fax:
Practice Address - Street 1:943 OAK RIDGE RD
Practice Address - Street 2:
Practice Address - City:MANITOU SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80829-2803
Practice Address - Country:US
Practice Address - Phone:719-201-2468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health