Healthcare Provider Details

I. General information

NPI: 1669163168
Provider Name (Legal Business Name): MICHELLE KOEWLER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARK CENTRE DR STE 207
WADSWORTH OH
44281-9482
US

IV. Provider business mailing address

246 NORTHLAND DR STE 200A
MEDINA OH
44256-3440
US

V. Phone/Fax

Practice location:
  • Phone: 330-725-9195
  • Fax: 307-259-1873
Mailing address:
  • Phone: 330-725-9195
  • Fax: 307-259-1873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2405827
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2606367
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: