Provider Demographics
NPI:1548363625
Name:PATTERSON, WANDA SUE (LCPC)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:SUE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:14961 W BELL RD STE A125
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-3200
Mailing Address - Country:US
Mailing Address - Phone:217-741-0040
Mailing Address - Fax:623-256-6531
Practice Address - Street 1:14961 W BELL RD STE A125
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3200
Practice Address - Country:US
Practice Address - Phone:855-775-0387
Practice Address - Fax:623-256-6531
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2019-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180000678101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor