Healthcare Provider Details

I. General information

NPI: 1033113667
Provider Name (Legal Business Name): JOAN WENZEL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3249 BARNEY AVE
PEKIN IL
61554-6234
US

IV. Provider business mailing address

395 CLAYTONS WAY
METAMORA IL
61548-8567
US

V. Phone/Fax

Practice location:
  • Phone: 309-347-5522
  • Fax: 309-347-7302
Mailing address:
  • Phone: 309-822-8172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: