Provider Demographics
NPI:1457665929
Name:WENGER, KAITLIN T (LCSW)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:T
Last Name:WENGER
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 1:418 STUMP RD STE 208
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18936-9645
Mailing Address - Country:US
Mailing Address - Phone:610-290-4896
Mailing Address - Fax:
Practice Address - Street 1:418 STUMP RD STE 208
Practice Address - Street 2:
Practice Address - City:MONTGOMERYVILLE
Practice Address - State:PA
Practice Address - Zip Code:18936-9645
Practice Address - Country:US
Practice Address - Phone:610-290-4896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0165351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical