Basic Information
| Provider Information | |||||||||
| NPI: | 1821542374 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | WENDI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 859 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MALTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437589007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409626111 | ||||||||
| FaxNumber: | 7409621657 | ||||||||
| Practice Location | |||||||||
| Address1: | 406 S 15TH ST | ||||||||
| Address2: | |||||||||
| City: | COSHOCTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 438122285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402953331 | ||||||||
| FaxNumber: | 7402953332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2016 | ||||||||
| LastUpdateDate: | 08/12/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | I0800238-SUPV | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.