Provider Demographics
NPI:1871915207
Name:WERTENBERGE, DAN
Entity type:Individual
Prefix:MR
First Name:DAN
Middle Name:
Last Name:WERTENBERGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 PARK ST N
Mailing Address - Street 2:SUITE 132
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44902-1722
Mailing Address - Country:US
Mailing Address - Phone:419-252-2555
Mailing Address - Fax:419-525-2558
Practice Address - Street 1:35 PARK ST N
Practice Address - Street 2:SUITE 132
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44902-1722
Practice Address - Country:US
Practice Address - Phone:419-252-2555
Practice Address - Fax:419-525-2558
Is Sole Proprietor?:No
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical