Provider Demographics
NPI:1114788148
Name:WENSEL, ANNE
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:WENSEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16291 EARL CT
Mailing Address - Street 2:
Mailing Address - City:LA PINE
Mailing Address - State:OR
Mailing Address - Zip Code:97739-9618
Mailing Address - Country:US
Mailing Address - Phone:785-317-6149
Mailing Address - Fax:541-749-2126
Practice Address - Street 1:155 NE REVERE AVE STE 150
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4147
Practice Address - Country:US
Practice Address - Phone:541-617-4544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23-07-10809101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)