Healthcare Provider Details

I. General information

NPI: 1659925980
Provider Name (Legal Business Name): AMANDA LYNN WENTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 BRYANT ST STE 500
DENVER CO
80211-4153
US

IV. Provider business mailing address

777 BANNOCK ST
DENVER CO
80204-4597
US

V. Phone/Fax

Practice location:
  • Phone: 720-212-7462
  • Fax:
Mailing address:
  • Phone: 720-423-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberCSW.09925590
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09925590
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: