Individual
KELLI LYNN WIETHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW LSCSW
Contact information
Practice address
751 E 63RD ST STE 120C, KANSAS CITY, MO 64110-3358
(816) 642-8634
Mailing address
751 E 63RD ST STE 120C, KANSAS CITY, MO 64110-3358
(816) 642-8634
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
076047
NY
1041C0700X
Clinical Social Worker
Primary
2008033440
MO
1041C0700X
Clinical Social Worker
3848
KS
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
10/13/2006
Last updated
01/16/2024
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