Provider Demographics
NPI:1699430207
Name:MALMGREN, WENDI (LMSW)
Entity type:Individual
Prefix:MS
First Name:WENDI
Middle Name:
Last Name:MALMGREN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 N GOVERNMENT WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-3337
Mailing Address - Country:US
Mailing Address - Phone:208-667-3340
Mailing Address - Fax:208-667-1645
Practice Address - Street 1:1609 N GOVERNMENT WAY
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3337
Practice Address - Country:US
Practice Address - Phone:208-667-3340
Practice Address - Fax:208-667-1645
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-41021101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health