Provider Demographics
NPI:1003242561
Name:WENIGER, LORI SUE (MED, NBCT)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:SUE
Last Name:WENIGER
Suffix:
Gender:F
Credentials:MED, NBCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 CHARLES GRIFFIN DR
Mailing Address - Street 2:
Mailing Address - City:GARNET VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19060-2209
Mailing Address - Country:US
Mailing Address - Phone:302-438-4368
Mailing Address - Fax:
Practice Address - Street 1:3222 CHARLES GRIFFIN DR
Practice Address - Street 2:
Practice Address - City:GARNET VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19060-2209
Practice Address - Country:US
Practice Address - Phone:302-438-4368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE5947171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator