Individual
THOMAS D BENTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, PH.D.
Contact information
Practice address
224 S BROADWAY ST, STANLEY, WI 54768-1011
(715) 644-4357
(715) 644-5053
Mailing address
224 S BROADWAY ST, STANLEY, WI 54768-1011
(715) 644-4357
(715) 644-5053
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1604-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
395-13300
—
WI
01
—
78034
SECURITY HEALTH PLAN
WI
Enumeration date
11/14/2006
Last updated
07/09/2007
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