Individual provider Active NPI

Wendy Frederickson Trudeau, LCSW

  • Clinical Social Worker
  • Sylvania, OH
National Provider Identifier
1174585988
Registry record updated Mar 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I.2405660 Issued in OH
Practice address
4045 Langston PL Apt L
Sylvania, OH 43560-9366
Phone
(843) 214-8054
Fax
(843) 954-0114
NPI assigned
Apr 5, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 13, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X I.2405660 OH Primary
Social Worker 104100000X 4701 SC
Clinical Social Worker 1041C0700X 7629-123 WI

Addresses

Primary practice location

4045 Langston PL Apt L
Sylvania, OH 43560-9366

Mailing address

4045 Langston PL Apt L
Sylvania, OH 43560-9366
Phone (843) 214-8054

Other practice location 1

700 Nexton Square Dr Ste 24
Summerville, SC 29486-7915
Phone (803) 397-5010

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050829000324 SC Practitioner - Clinical Social Worker 4082645148

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
I.2405660OHMDClinical Social Worker
7629-123WIMDClinical Social Worker
4701SCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lutheran Social Services of Wisconsin and Upper Michigan, Inc. Social Worker Past Accepting new patients
Lutheran Social Services of Wisconsin and Upper Michigan, Inc. Social Worker PastSince Feb 27, 2022 Accepting new patients
Bay Counseling, LLC Clinical Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741824000000",
    "number": "1174585988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4045 LANGSTON PL APT L",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435609366",
            "telephone_number": "843-214-8054",
            "fax_number": "843-954-0114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4045 LANGSTON PL APT L",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435609366",
            "telephone_number": "843-214-8054",
            "fax_number": "843-954-0114"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 Nexton Square Dr Ste 24",
            "address_purpose": "LOCATION",
            "city": "Summerville",
            "state": "SC",
            "postal_code": "294867915",
            "country_code": "US",
            "telephone_number": "803-397-5010",
            "fax_number": "843-954-0114",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TRUDEAU",
        "first_name": "WENDY",
        "middle_name": "FREDERICKSON",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-05",
        "last_updated": "2025-03-13",
        "certification_date": "2025-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.2405660",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "SC",
            "license": "4701",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "7629-123",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sylvania, OH

Sources for this page

Verify at the official NPI Registry.