Healthcare Provider Details

I. General information

NPI: 1548803331
Provider Name (Legal Business Name): KATHERINE GAIL WENNINGER MSW, LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHERINE GAIL BOYER MSW, LISW

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3454 OAK ALLEY CT STE 504
TOLEDO OH
43606-1356
US

IV. Provider business mailing address

3454 OAK ALLEY CT STE 504
TOLEDO OH
43606-1356
US

V. Phone/Fax

Practice location:
  • Phone: 419-318-8533
  • Fax:
Mailing address:
  • Phone: 419-318-8533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI2102660
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberS.1904488
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: