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General NPI Number Information
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NPI Number | 1912099862
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Entity Type | Individual
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Provider Name | WENDY G ETZKORN MSW LICSW
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Gender | Female
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 104 STATION PLACE WAY APPALACHIAN FAMILY MEDICINE
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City | HURRICANE
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State | WV
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Zip | 25526
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Country | US
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Telephone | 304-757-7788
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Fax | 304-201-1140
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Provider Business Mailing Address
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Address Line | 8 STONEGATE DRIVE
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City | HURRICANE
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State | WV
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Zip | 25526
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Country | US
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Telephone | 304-545-8629
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | DP00454495
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License Number State | WV
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