Individual
KELLY A WIECZOREK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
6500 ROCKSIDE RD STE 385, INDEPENDENCE, OH 44131-2353
(216) 468-5000
Mailing address
6500 ROCKSIDE RD STE 385, INDEPENDENCE, OH 44131-2353
(216) 468-5000
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
E.2404015
OH
101YP2500X
Professional Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2871101
—
OH
Enumeration date
04/14/2020
Last updated
03/04/2025
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