Provider Demographics
NPI:1699727735
Name:BODICK, WENDYLEIGH KATHLEEN (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:WENDYLEIGH
Middle Name:KATHLEEN
Last Name:BODICK
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:113 DAVIDSON RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-7800
Mailing Address - Country:US
Mailing Address - Phone:704-892-2254
Mailing Address - Fax:704-892-0366
Practice Address - Street 1:21300 CATAWBA AVE
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8505
Practice Address - Country:US
Practice Address - Phone:704-892-2254
Practice Address - Fax:704-892-0366
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0037031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002858Medicaid