Provider Demographics
NPI:1891245171
Name:WENZEL, KENDRA LEIGH
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:LEIGH
Last Name:WENZEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:LEIGH
Other - Last Name:CROSBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2232 W BERWYN AVE
Mailing Address - Street 2:3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1149
Mailing Address - Country:US
Mailing Address - Phone:971-221-4611
Mailing Address - Fax:
Practice Address - Street 1:6601 N AVONDALE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1572
Practice Address - Country:US
Practice Address - Phone:773-774-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.009903101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional