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General NPI Number Information
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NPI Number | 1225528417
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Entity Type | Individual
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Provider Name | KIMBERLY A WETZEL LSW
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Gender | Female
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Dates
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Enumeration Date | 05/14/2018
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Last Update Date | 06/22/2018
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Provider Practice Location Address
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Address Line | 201 MEDICAL PARK DR.
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City | DOVER
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State | OH
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Zip | 44622
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Country | US
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Telephone | 330-343-6631
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Fax |
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Provider Business Mailing Address
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Address Line | 11004 PORTAGE ST NW
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City | CANAL FULTON
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State | OH
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Zip | 44614-9446
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Country | US
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Telephone | 330-933-1776
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.1701019
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License Number State | OH
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