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General NPI Number Information
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NPI Number | 1801192026
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Entity Type | Organization
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Legal Business Name | WETZEL THERAPY INC
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Dates
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Enumeration Date | 02/05/2011
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Last Update Date | 04/23/2014
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Provider Practice Location Address
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Address Line | 17903 STATE ROAD 23 SUITE #3
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City | SOUTH BEND
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State | IN
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Zip | 46635-1642
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Country | US
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Telephone | 574-243-7730
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Fax | 574-243-7735
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Provider Business Mailing Address
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Address Line | 17903 STATE ROAD 23 SUITE #3
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City | SOUTH BEND
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State | IN
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Zip | 46635-1642
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Country | US
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Telephone | 574-243-7730
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Fax | 574-243-7735
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Authorized Official
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Title or Position | SOLE PROVIDER
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Name | BRENDA E WETZEL
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Credential | LCSW
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Telephone | 574-243-7730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34001342A
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License Number State | IN
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