Provider Demographics
NPI:1386793149
Name:FRY WENDT, SHERRI DIANE (PHD)
Entity type:Individual
Prefix:DR
First Name:SHERRI
Middle Name:DIANE
Last Name:FRY WENDT
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 1:7803 N MERSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-1275
Mailing Address - Country:US
Mailing Address - Phone:816-468-9278
Mailing Address - Fax:816-756-0743
Practice Address - Street 1:4901 MAIN ST STE 408
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-2635
Practice Address - Country:US
Practice Address - Phone:816-756-2773
Practice Address - Fax:816-756-0743
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01311103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMO PY01311OtherLICENSE NUMBER
MOMO PY01311OtherLICENSE NUMBER