Provider Demographics
NPI:1316040942
Name:CHRYST, WENDY (ICSW)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:CHRYST
Suffix:
Gender:F
Credentials:ICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270630 ABE LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-5777
Mailing Address - Country:US
Mailing Address - Phone:715-613-0796
Mailing Address - Fax:
Practice Address - Street 1:207630 ABE LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-4387
Practice Address - Country:US
Practice Address - Phone:715-613-0796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8712104100000X
MI68011156051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43559400Medicaid
S95071Medicare UPIN