Provider Demographics
NPI:1801962865
Name:MCDOUGAL, WENDY ANN (MA)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:ANN
Last Name:MCDOUGAL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:ANN
Other - Last Name:NEEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:300 OZARK TRAIL DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2166
Mailing Address - Country:US
Mailing Address - Phone:314-853-9580
Mailing Address - Fax:
Practice Address - Street 1:300 OZARK TRAIL DR
Practice Address - Street 2:SUITE 220
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2166
Practice Address - Country:US
Practice Address - Phone:314-853-9580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS1073101YP2500X
MOSW24081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical