Individual
MRS. KATHRYN L WENZEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
6821 MAIN ST STE C, BONNERS FERRY, ID 83805-8552
(208) 267-9228
Mailing address
6821 MAIN ST SUITE C, BONNERS FERRY, ID 83805
(208) 267-9228
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
09924548
CO
1041C0700X
Clinical Social Worker
Primary
36243
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09924548
COLORADO DEPARTMENT OF REGULATORY AGENCIES
CO
01
—
12018496
CAQH
CO
01
—
36243
BUREAU OF OCCUPATIONAL LICENSES
ID
Enumeration date
05/14/2009
Last updated
01/11/2017
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