| Doctor Name: | MR. CURTIS LEE WENNERDAHL |
| NPI Number: | 1497797542 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSW |
| License Number: | |
| Business Practice Address: | 34930 N Highway 45 Suite 110 Lake Villa, IL - 600467537 |
| Business Phone Number: | 8478315925 |
| Business Fax Number: | 8475740841 |
| Mailing Address: | 1180 Sherwood Rd, HIGHLAND PARK |
| State: | IL |
| Postal Code: | 600352934 |
| Phone Number: | 8478315925 |
| Fax Number: | 8475740841 |
| NPI Enumeration Date: | 06/12/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |