Provider Demographics
NPI:1134248727
Name:WENTZ, DEBORAH ELLEN (MSW)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ELLEN
Last Name:WENTZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 W STADIUM BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-7009
Mailing Address - Country:US
Mailing Address - Phone:734-996-9123
Mailing Address - Fax:734-761-2111
Practice Address - Street 1:1829 W STADIUM BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-7009
Practice Address - Country:US
Practice Address - Phone:734-996-9123
Practice Address - Fax:734-761-2111
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010150651041C0700X
MI4101005821106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist