Individual
KEVIN M WENTZEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRM
Contact information
Practice address
125 SW C ST, MADRAS, OR 97741-1458
(541) 777-7847
(541) 512-7090
Mailing address
389 SW SCALEHOUSE CT STE 130, BEND, OR 97702-3241
(541) 777-7847
(541) 512-7090
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
21-CRM-442
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21-CRM-442
MHACBO
OR
Enumeration date
04/06/2021
Last updated
04/06/2021
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