Provider Demographics
NPI:1407581176
Name:WENTZEL, CAREY SULLIVAN (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:SULLIVAN
Last Name:WENTZEL
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:CAREY
Other - Middle Name:MEYER
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1293 SUMMIT AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-2442
Mailing Address - Country:US
Mailing Address - Phone:440-481-1011
Mailing Address - Fax:
Practice Address - Street 1:8100 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-4506
Practice Address - Country:US
Practice Address - Phone:440-543-6766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.20222031-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist