Healthcare Provider Details

I. General information

NPI: 1396679866
Provider Name (Legal Business Name): KATHLEEN WIETING ATR-BC, CLAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 DANBURY RD STE 210
WILTON CT
06897-4075
US

IV. Provider business mailing address

204 ROUTE 37 S
SHERMAN CT
06784-2628
US

V. Phone/Fax

Practice location:
  • Phone: 203-762-6442
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number54
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: