Provider Demographics
NPI:1477348928
Name:WENZEL, LANCE AARON
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:AARON
Last Name:WENZEL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2884 E FOX RD
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-8807
Mailing Address - Country:US
Mailing Address - Phone:618-780-0430
Mailing Address - Fax:
Practice Address - Street 1:2100 E CALUMET ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-6511
Practice Address - Country:US
Practice Address - Phone:618-532-7391
Practice Address - Fax:618-532-8952
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer