Provider Demographics
NPI:1871730887
Name:WENTZ, LISA KATHLEEN (MA)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:KATHLEEN
Last Name:WENTZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:KATHLEEN
Other - Last Name:COSTELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1133 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5055
Mailing Address - Country:US
Mailing Address - Phone:360-676-2164
Mailing Address - Fax:
Practice Address - Street 1:1133 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5055
Practice Address - Country:US
Practice Address - Phone:360-676-2164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor