Doctor Name: | JOAN WENZEL |
NPI Number: | 1033113667 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | |
Business Practice Address: | 3249 Barney Ave Pekin, IL - 615546234 |
Business Phone Number: | 3093475522 |
Business Fax Number: | 3093477302 |
Mailing Address: | 395 Claytons Way, METAMORA |
State: | IL |
Postal Code: | 615488567 |
Phone Number: | 3098228172 |
Fax Number: | |
NPI Enumeration Date: | 06/10/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |