Provider Demographics
NPI:1851181630
Name:ANDERSEN, WENDY (LMT)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:ANDERSEN
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 14TH AVE N
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-7331
Mailing Address - Country:US
Mailing Address - Phone:612-239-2189
Mailing Address - Fax:
Practice Address - Street 1:14332 21ST AVE N STE 200
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-4566
Practice Address - Country:US
Practice Address - Phone:763-398-0365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMT2025003225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist