Provider Demographics
NPI:1699898403
Name:CLECKNER, WENDI LEE (LM)
Entity type:Individual
Prefix:MS
First Name:WENDI
Middle Name:LEE
Last Name:CLECKNER
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 W MARLBORO DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2177
Mailing Address - Country:US
Mailing Address - Phone:480-628-2135
Mailing Address - Fax:480-247-6729
Practice Address - Street 1:714 W MARLBORO DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2177
Practice Address - Country:US
Practice Address - Phone:480-628-2135
Practice Address - Fax:480-247-6729
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ127176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife