MEDICARE: JENNIFER JANE WENTZ LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	34011417A	IN

General Provider Information

NPI Number	:	1265267223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER JANE WENTZ LCSW

Provider Business Mailing Address
First Line	:	3112 S WALNUT ST
Second Line	:
City	:	YORKTOWN
State	:	IN
Zip	:	47396-1622
Country	:	US
Telephone Number	:	765-748-3560
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 W UNIVERSITY AVE STE 3500A
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47303-3428
Country	:	US
Telephone Number	:	765-702-2819
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2024
Last Update Date	:	12/10/2025

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