Healthcare Provider Details

I. General information

NPI: 1922040146
Provider Name (Legal Business Name): TODD A WABEKE LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6929 W 130TH ST SUITE 500
PARMA HEIGHTS OH
44130-7878
US

IV. Provider business mailing address

6929 W 130TH ST SUITE 500
PARMA HEIGHTS OH
44130-7878
US

V. Phone/Fax

Practice location:
  • Phone: 440-842-6867
  • Fax: 440-842-8914
Mailing address:
  • Phone: 440-842-6867
  • Fax: 440-842-8914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number9534
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number9534
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: