Provider Demographics
NPI:1982437638
Name:WENDLANDT, KRISTIN MARIE
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARIE
Last Name:WENDLANDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W309 S4366 STATE ROAD 83
Mailing Address - Street 2:
Mailing Address - City:GENESEE DEPOT
Mailing Address - State:WI
Mailing Address - Zip Code:53127
Mailing Address - Country:US
Mailing Address - Phone:414-702-0241
Mailing Address - Fax:
Practice Address - Street 1:620 S 76TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-1599
Practice Address - Country:US
Practice Address - Phone:414-292-4242
Practice Address - Fax:414-453-2538
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10131-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical