Provider Demographics
NPI:1710616511
Name:WENTZ, TRISTA (BSW)
Entity Type:Individual
Prefix:MS
First Name:TRISTA
Middle Name:
Last Name:WENTZ
Suffix:
Gender:F
Credentials:BSW
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 39
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:ND
Mailing Address - Zip Code:58784-0039
Mailing Address - Country:US
Mailing Address - Phone:701-628-2925
Mailing Address - Fax:701-628-3175
Practice Address - Street 1:18 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:ND
Practice Address - Zip Code:58784-0039
Practice Address - Country:US
Practice Address - Phone:701-628-2925
Practice Address - Fax:701-628-3175
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator