Provider Demographics
NPI:1699096230
Name:KUKUWICH, WENDEE ELLEN (MA, MS, LPC)
Entity type:Individual
Prefix:MS
First Name:WENDEE
Middle Name:ELLEN
Last Name:KUKUWICH
Suffix:
Gender:F
Credentials:MA, MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:997 SHADY LANE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-6142
Mailing Address - Country:US
Mailing Address - Phone:808-783-3142
Mailing Address - Fax:
Practice Address - Street 1:2305 RIDGE RD STE 101C
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-5163
Practice Address - Country:US
Practice Address - Phone:720-731-2253
Practice Address - Fax:877-323-9782
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66077101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional