Provider Demographics
NPI:1609588680
Name:WEHMANN, KYLE A (LSW)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:A
Last Name:WEHMANN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S EARL AVE STE 4A
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-3265
Mailing Address - Country:US
Mailing Address - Phone:765-297-0090
Mailing Address - Fax:765-297-0098
Practice Address - Street 1:401 S EARL AVE STE 4A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-3265
Practice Address - Country:US
Practice Address - Phone:765-297-0090
Practice Address - Fax:765-297-0098
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33010563A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker