Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
N | 102L00000X | Psychologist | 382 | MT |
N | 103T00000X | Psychologist | 382 | MT |
N | 102L00000X | Psychologist | PY0401 | NV |
N | 103T00000X | Psychologist | PY0401 | NV |
Y | 103G00000X | Clinical Psychologist | PSY-004631 | AZ |
Y | 103TC0700X | Clinical Psychologist | PSY-004631 | AZ |
N | 103TH0100X | Health Service |
NPI | 1558591172 |
---|---|
Provider Name | Dr. Laura Marie Wendlandt |
First Address | San Tan Valley, AZ 85140-9866 |
Second Address | Glendale, AZ 85306-1873 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2009 |
Last Update Date | 13/08/2020 |