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General NPI Number Information
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NPI Number | 1609681626
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Entity Type | Individual
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Provider Name | KELSEY WIERZGACZ
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Gender | Female
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Dates
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Enumeration Date | 02/07/2025
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 905 W GLEN PARK AVE
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City | GRIFFITH
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State | IN
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Zip | 46319-2028
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Country | US
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Telephone | 219-501-1729
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Fax |
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Provider Business Mailing Address
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Address Line | 3113 GLENWOOD ST
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City | HIGHLAND
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State | IN
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Zip | 46322-1237
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Country | US
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Telephone |
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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 | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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