Provider Demographics
NPI:1487478822
Name:CALLAWAY, WENDI M
Entity type:Individual
Prefix:
First Name:WENDI
Middle Name:M
Last Name:CALLAWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4602 GREAT BLUE HERON DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812-6332
Mailing Address - Country:US
Mailing Address - Phone:863-258-1783
Mailing Address - Fax:
Practice Address - Street 1:4602 GREAT BLUE HERON DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33812-6332
Practice Address - Country:US
Practice Address - Phone:863-258-1783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician