Individual
KELLY WAKELAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
91 NORTHWEST DR, PLAINVILLE, CT 06062-1552
(951) 206-1773
Mailing address
91 NORTHWEST DR, PLAINVILLE, CT 06062-1552
(951) 206-1773
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
5296
CT
Other
Enumeration date
08/13/2020
Last updated
08/13/2020
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