Healthcare Provider Details

I. General information

NPI: 1184368383
Provider Name (Legal Business Name): KELLIE ANN WOJCIECHOWSKI LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2022
Last Update Date: 04/24/2022
Certification Date: 04/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 VILLAGE LN
BERWICK PA
18603-5741
US

IV. Provider business mailing address

5 SUNRISE TER
BERWICK PA
18603-9000
US

V. Phone/Fax

Practice location:
  • Phone: 570-764-6444
  • Fax:
Mailing address:
  • Phone: 570-204-7479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW138523
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: