Wendy Patricia Abbott I, LICSW
Individual provider Active NPI Specialist · Woodbury, MN
NPI 1285797175 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1285797175
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 15440 (MN)
- Practice address
- 8490 Woodbury Xing
Ste 107
Woodbury, MN 55125-9433 - Phone
- (651) 238-9447
- Fax
- (651) 731-6345
- NPI assigned
- Dec 19, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120406000183 | MN | Practitioner - Clinical Social Worker | 5193986875 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15440 | MN | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| James Thomas Richardson | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 15440 | MN | Yes |
Addresses
Primary practice location
8490 Woodbury Xing
Ste 107
Woodbury, MN 55125-9433
Mailing address
8490 Woodbury Xing
Ste 107
Woodbury, MN 55125-9433
Phone (651) 238-9447
Other providers in Woodbury, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.