Provider Demographics
NPI:1366793275
Name:MCGILL, WENDY R (LICSW)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:R
Last Name:MCGILL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:R
Other - Last Name:PTAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1660 S. COLUMBIAN WAY
Mailing Address - Street 2:S-122-SWS
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1532
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1660 S COLUMBIAN WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-762-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 605941941041C0700X
WASC60284079104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WASC60284079OtherSOCIAL WORKER ASSOCIATE INDEPENDENT CLINICAL LICENSE
WALW 60594194OtherSOCIAL WORKER INDEPENDENT CLINICAL LICENSE