Individual
DR. MICHAEL GERARD WISNIEWSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
29425 CHAGRIN BLVD, SUITE 301, BEACHWOOD, OH 44122-4639
(216) 292-0610
(216) 292-0627
Mailing address
29425 CHAGRIN BLVD, SUITE 301, BEACHWOOD, OH 44122-4639
(216) 292-0610
(216) 292-0627
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
3607
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0692175
—
OH
Enumeration date
07/10/2006
Last updated
07/08/2007
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