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NPI Code Detail

MEDICARE: KATHY WENGER LMHC

MEDICARE: KATHY WENGER LMHC
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
11041C0700XClinical Social Worker39001807AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2000000492651OTHERINANTHEM
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4000000492651OTHERINUNICARE

General Provider Information

NPI Number : 1457497679
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHY WENGER LMHC
Provider Business Mailing Address
First Line : 1485 M 139
Second Line :
City : BENTON HARBOR
State : MI
Zip : 49022-5711
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1485 M 139
Second Line :
City : BENTON HARBOR
State : MI
Zip : 49022-5711
Country : US
Telephone Number : 269-925-0585
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2007
Last Update Date : 01/28/2026

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