Individual
KATELYN RICHELLE WIERENGA
Active
Individual
KATELYN RICHELLE WIERENGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-22214
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LMSW-19606
STATE OF ARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS
AZ
Enumeration date
08/19/2021
Last updated
04/29/2024
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