Provider Demographics
NPI:1780747774
Name:WENZSHERRILL, KIMBERLY G (LCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:G
Last Name:WENZSHERRILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-0765
Mailing Address - Country:US
Mailing Address - Phone:270-748-5638
Mailing Address - Fax:270-499-7532
Practice Address - Street 1:329 MADISON ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-0765
Practice Address - Country:US
Practice Address - Phone:270-748-5638
Practice Address - Fax:270-499-7532
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34821041C0700X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3482OtherLCSW
KY7100277890Medicaid