Provider Demographics
NPI:1073367298
Name:WENZL, SAMUEL (PLMHP)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:WENZL
Suffix:
Gender:
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8902 N 169TH ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68007-3272
Mailing Address - Country:US
Mailing Address - Phone:402-216-2697
Mailing Address - Fax:
Practice Address - Street 1:8902 N 169TH ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NE
Practice Address - Zip Code:68007-3272
Practice Address - Country:US
Practice Address - Phone:402-216-2697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13846101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health