| Doctor Name: | MARY ALICE WENTLING |
| NPI Number: | 1174779953 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCPC |
| License Number: | 180005096 |
| Business Practice Address: | 501 Woodland Dr Dixon, IL - 610218937 |
| Business Phone Number: | 8159736111 |
| Business Fax Number: | |
| Mailing Address: | 501 Woodland Dr, DIXON |
| State: | IL |
| Postal Code: | 610218937 |
| Phone Number: | 8159736111 |
| Fax Number: | |
| NPI Enumeration Date: | 08/13/2008 |
| NPI Last Update Date: | 08/13/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 180005096 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |