Provider Demographics
NPI:1750394235
Name:GOETZ, WENDY ANNE (LLP)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:ANNE
Last Name:GOETZ
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:ANNE
Other - Last Name:HAYEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLP
Mailing Address - Street 1:6549 TOWN CENTER DR STE A
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-4824
Mailing Address - Country:US
Mailing Address - Phone:248-620-6400
Mailing Address - Fax:248-620-6405
Practice Address - Street 1:42669 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1653
Practice Address - Country:US
Practice Address - Phone:586-412-5321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011648103TC0700X
MI6361006934103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical