Provider Demographics
NPI:1043674906
Name:WENNER, KERRI (LCSW)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:WENNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 JIMAR WAY
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-1510
Mailing Address - Country:US
Mailing Address - Phone:054-388-9528
Mailing Address - Fax:
Practice Address - Street 1:910 JIMAR WAY
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-1510
Practice Address - Country:US
Practice Address - Phone:054-388-9528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5597104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker