MEDICARE: DAVID WENZEL PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	1012	OR

General Provider Information

NPI Number	:	1801060496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID WENZEL PH.D.

Provider Business Mailing Address
First Line	:	46575 SE JADRNY RD
Second Line	:
City	:	SANDY
State	:	OR
Zip	:	97055-7463
Country	:	US
Telephone Number	:	503-803-0444
Fax Number	:

Provider Business Practice Location Address
First Line	:	39085 PIONEER BLVD STE 104
Second Line	:
City	:	SANDY
State	:	OR
Zip	:	97055-8062
Country	:	US
Telephone Number	:	503-668-5001
Fax Number	:	503-388-3162

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2008
Last Update Date	:	04/24/2018

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Directions to “ DAVID WENZEL PH.D.” Practice Location

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