Provider Demographics
NPI:1144649799
Name:ZINCK-LADD, WENDY (CRSS)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:ZINCK-LADD
Suffix:
Gender:F
Credentials:CRSS
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:JO
Other - Last Name:ZINCK-LADD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRSS
Mailing Address - Street 1:19503 S.W. VILLAGES PARKWAY, BLDG A
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34293
Mailing Address - Country:US
Mailing Address - Phone:941-492-4300
Mailing Address - Fax:
Practice Address - Street 1:19503 S.W.VILLAGES PARKWAY, BLDG. A
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34293
Practice Address - Country:US
Practice Address - Phone:941-492-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator