Provider Demographics
NPI:1326312653
Name:WINTJEN, SHERRI LIN (LMT)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:LIN
Last Name:WINTJEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-6105
Mailing Address - Country:US
Mailing Address - Phone:330-372-2324
Mailing Address - Fax:330-372-2309
Practice Address - Street 1:2219 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6105
Practice Address - Country:US
Practice Address - Phone:330-372-2324
Practice Address - Fax:330-372-2309
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-05
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.015095-T-Z174400000X
PAMSG007535174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist