Provider Demographics
NPI:1538618095
Name:WILTSE, BENJAMIN CHAUNCEY (LMSW)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:CHAUNCEY
Last Name:WILTSE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-1333
Mailing Address - Country:US
Mailing Address - Phone:989-965-0318
Mailing Address - Fax:
Practice Address - Street 1:511 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-9251
Practice Address - Country:US
Practice Address - Phone:989-345-5571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801099945104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker