Provider Demographics
NPI:1174585988
Name:TRUDEAU, WENDY FREDERICKSON (LCSW)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:FREDERICKSON
Last Name:TRUDEAU
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 LANGSTON PL APT L
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-9366
Mailing Address - Country:US
Mailing Address - Phone:843-214-8054
Mailing Address - Fax:843-954-0114
Practice Address - Street 1:4045 LANGSTON PL APT L
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-9366
Practice Address - Country:US
Practice Address - Phone:843-214-8054
Practice Address - Fax:843-954-0114
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.24056601041C0700X
SC4701104100000X
WI7629-1231041C0700X
SC10021612101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1174585988Medicaid
WIWI1777002Medicare UPIN