Provider Demographics
NPI:1801060496
Name:WENZEL, DAVID (PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:WENZEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46575 SE JADRNY RD
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-7463
Mailing Address - Country:US
Mailing Address - Phone:503-803-0444
Mailing Address - Fax:
Practice Address - Street 1:39085 PIONEER BLVD STE 104
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-8062
Practice Address - Country:US
Practice Address - Phone:503-668-5001
Practice Address - Fax:503-388-3162
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1012101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional