Provider Demographics
NPI:1609934769
Name:WUERTZ, PHILIP A (LCSW)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:A
Last Name:WUERTZ
Suffix:
Gender:M
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:PO BOX 3407
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47733-3407
Mailing Address - Country:US
Mailing Address - Phone:812-146-5125
Mailing Address - Fax:812-465-7170
Practice Address - Street 1:8600 UNIVERSITY BLVD
Practice Address - Street 2:RM HP0091
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-3534
Practice Address - Country:US
Practice Address - Phone:812-465-1250
Practice Address - Fax:812-465-7170
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002562A104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000220593Medicaid
IN000000220593Medicaid
IN533200CMedicare PIN
IN800000916Medicare PIN