Provider Demographics
NPI:1518257922
Name:WENTZ, SALLY (LPC)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:WENTZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E MAIN ST STE 110
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4163
Mailing Address - Country:US
Mailing Address - Phone:503-640-9892
Mailing Address - Fax:503-648-9732
Practice Address - Street 1:400 E MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4163
Practice Address - Country:US
Practice Address - Phone:503-640-9892
Practice Address - Fax:503-648-9732
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1656101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional