Healthcare Provider Details

I. General information

NPI: 1174610612
Provider Name (Legal Business Name): ABBY WRENTMORE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 ELLEN KAY DR SUITE B
MARION OH
43302-6286
US

IV. Provider business mailing address

1125 ELLEN KAY DR SUITE B
MARION OH
43302-6286
US

V. Phone/Fax

Practice location:
  • Phone: 740-387-3087
  • Fax: 740-382-5034
Mailing address:
  • Phone: 740-387-3087
  • Fax: 740-382-5034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS-0600778
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: