Provider Demographics
NPI:1780616144
Name:ZENTNER, THOMAS R (PHD SC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:ZENTNER
Suffix:
Gender:M
Credentials:PHD SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 N 28TH AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401
Mailing Address - Country:US
Mailing Address - Phone:715-848-1346
Mailing Address - Fax:715-848-0640
Practice Address - Street 1:520 N 28TH AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401
Practice Address - Country:US
Practice Address - Phone:715-848-1346
Practice Address - Fax:715-845-1244
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI554057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39008500Medicaid
WI39008500Medicaid