Provider Demographics
NPI:1386094928
Name:MOYNIHAN, WENDIE S (QMHA)
Entity type:Individual
Prefix:
First Name:WENDIE
Middle Name:S
Last Name:MOYNIHAN
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:MS
Other - First Name:WENDIE
Other - Middle Name:S
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:QMHA
Mailing Address - Street 1:PO BOX 852
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-0142
Mailing Address - Country:US
Mailing Address - Phone:541-423-2633
Mailing Address - Fax:
Practice Address - Street 1:175 W B ST BLDG B2
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-4575
Practice Address - Country:US
Practice Address - Phone:541-423-2633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health