Provider Demographics
NPI:1609159714
Name:WENKER, EMILY M (MED, BCBA)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:M
Last Name:WENKER
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 ENID AVE
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5414
Mailing Address - Country:US
Mailing Address - Phone:202-316-4667
Mailing Address - Fax:
Practice Address - Street 1:616 ENID AVE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-5414
Practice Address - Country:US
Practice Address - Phone:202-316-4667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-25
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-11-9006103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst