Healthcare Provider Details
I. General information
NPI: 1265267223
Provider Name (Legal Business Name): JENNIFER JANE WENTZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 09/07/2024
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2401 W UNIVERSITY AVE STE 3500A
MUNCIE IN
47303-3428
US
IV. Provider business mailing address
3112 S WALNUT ST
YORKTOWN IN
47396-1622
US
V. Phone/Fax
- Phone: 765-702-2819
- Fax:
- Phone: 765-748-3560
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | 34011417A |
| License Number State | IN |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: