Provider Demographics
NPI:1023160546
Name:REBERT, WENDY (PHD)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:REBERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:MAGNOLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2020 PEACHTREE RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1426
Mailing Address - Country:US
Mailing Address - Phone:404-350-7323
Mailing Address - Fax:404-350-7694
Practice Address - Street 1:1109 SPRING DR
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5345
Practice Address - Country:US
Practice Address - Phone:334-745-2760
Practice Address - Fax:334-745-7998
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002491103TC0700X
AL550103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL890011270Medicaid