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General NPI Number Information
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NPI Number | 1992499339
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Entity Type | Individual
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Provider Name | MARLENA FAYE WISNASKY
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Gender | Female
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Dates
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Enumeration Date | 06/07/2023
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Last Update Date | 06/07/2023
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Provider Practice Location Address
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Address Line | 15455 CONWAY RD STE 117
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City | CHESTERFIELD
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State | MO
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Zip | 63017-2022
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Country | US
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Telephone | 636-675-7566
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Fax |
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Provider Business Mailing Address
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Address Line | 4243 S PERADOTTI RD
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-4543
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Country | US
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Telephone | 618-670-6067
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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