Healthcare Provider Details

I. General information

NPI: 1699694521
Provider Name (Legal Business Name): STEPHANIE LEIGH WENTWORTH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2631 GATTIS SCHOOL RD STE 135
ROUND ROCK TX
78664-2828
US

IV. Provider business mailing address

370 TOYAH DR
DRIPPING SPRINGS TX
78620-2368
US

V. Phone/Fax

Practice location:
  • Phone: 512-298-1324
  • Fax:
Mailing address:
  • Phone: 713-703-6776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119357
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: