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General NPI Number Information
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NPI Number | 1790447001
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Entity Type | Individual
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Provider Name | ANTHONY M WENTZ LAC
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Gender | Male
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Dates
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Enumeration Date | 10/13/2021
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 7448 68TH AVE. NE
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City | CANDO
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State | ND
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Zip | 58324
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Country | US
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Telephone | 701-968-4056
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Fax | 701-968-4456
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Provider Business Mailing Address
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Address Line | 413 4TH ST NE STE 1
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City | DEVILS LAKE
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State | ND
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Zip | 58301-2542
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Country | US
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Telephone | 701-665-3263
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6940
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1914
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License Number State | ND
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