Individual
COLLEEN WETHERWAX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
13300 AQUILLA RD, CHARDON, OH 44024-7944
(440) 279-2090
(440) 285-2574
Mailing address
12557 RAVENWOOD DR, CHARDON, OH 44024-9009
(440) 285-3568
(440) 285-2207
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I2002109
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0265005
—
OH
Enumeration date
05/31/2016
Last updated
05/22/2020
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