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NPI Code Detail

MEDICARE: SHANNON LYNN WYZKOSKI LPC

MEDICARE: SHANNON LYNN WYZKOSKI LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorPC005963PA

General Provider Information

NPI Number : 1285990630
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON LYNN WYZKOSKI LPC
Provider Business Mailing Address
First Line : 4025 HAZELJACK DR
Second Line :
City : BETHEL PARK
State : PA
Zip : 15102-2323
Country : US
Telephone Number : 412-427-9034
Fax Number :
Provider Business Practice Location Address
First Line : 5250 CASTE DR
Second Line :
City : PITTSBURGH
State : PA
Zip : 15236-1502
Country : US
Telephone Number : 412-469-9771
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2012
Last Update Date : 07/15/2021

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