Provider Demographics
NPI:1164763066
Name:WETZEL, KATHERINE HARDING (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:HARDING
Last Name:WETZEL
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 1:513 DODSON RD
Mailing Address - Street 2:Y4
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-7393
Mailing Address - Country:US
Mailing Address - Phone:501-993-1053
Mailing Address - Fax:
Practice Address - Street 1:513 DODSON RD
Practice Address - Street 2:Y4
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-7393
Practice Address - Country:US
Practice Address - Phone:501-993-1053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 279261041C0700X
AR6720-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical