Provider Demographics
NPI:1942767520
Name:WENTE, KRISTEN H (LSW, MSW, LICDC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:H
Last Name:WENTE
Suffix:
Gender:F
Credentials:LSW, MSW, LICDC
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:H
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:1804 E 55TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-3602
Mailing Address - Country:US
Mailing Address - Phone:216-762-1237
Mailing Address - Fax:
Practice Address - Street 1:37 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1910
Practice Address - Country:US
Practice Address - Phone:330-996-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.167963101YA0400X
OHS.2004929104100000X
OHLICDC.162490101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0405812Medicaid