Provider Demographics
NPI:1265267223
Name:WENTZ, JENNIFER JANE (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JANE
Last Name:WENTZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3112 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47396-1622
Mailing Address - Country:US
Mailing Address - Phone:765-748-3560
Mailing Address - Fax:
Practice Address - Street 1:2401 W UNIVERSITY AVE STE 3500A
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3428
Practice Address - Country:US
Practice Address - Phone:765-702-2819
Practice Address - Fax:371-222-2062
Is Sole Proprietor?:No
Enumeration Date:2024-09-07
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34011417A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical