Provider Demographics
NPI:1366959645
Name:BUSH, WENDY JUDITH (MS, BCBA)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:JUDITH
Last Name:BUSH
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 PEDLEY RD SPC 12
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-2822
Mailing Address - Country:US
Mailing Address - Phone:909-524-8486
Mailing Address - Fax:
Practice Address - Street 1:1720 12TH AVE APT 213
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-3839
Practice Address - Country:US
Practice Address - Phone:909-524-8486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-17-28531103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst