Provider Demographics
NPI:1336547967
Name:CZOPP, WENDY MICHELE (PHD)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:MICHELE
Last Name:CZOPP
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:WENDY
Other - Middle Name:MICHELE
Other - Last Name:MAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1616 CORNWALL AVE
Mailing Address - Street 2:STE. 100
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4648
Mailing Address - Country:US
Mailing Address - Phone:360-305-3275
Mailing Address - Fax:
Practice Address - Street 1:1616 CORNWALL AVE
Practice Address - Street 2:STE. 100
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4648
Practice Address - Country:US
Practice Address - Phone:360-305-3275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-13
Last Update Date:2014-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60455199103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent