MEDICARE: KIAH ELIZABETH WROBLESKI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist	0002436	OH

General Provider Information

NPI Number	:	1124775036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIAH ELIZABETH WROBLESKI

Provider Business Mailing Address
First Line	:	7533 FLINTSHIRE DR
Second Line	:
City	:	ALEXANDRIA
State	:	KY
Zip	:	41001-1438
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7533 FLINTSHIRE DR
Second Line	:
City	:	ALEXANDRIA
State	:	KY
Zip	:	41001-1438
Country	:	US
Telephone Number	:	859-638-7758
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2022
Last Update Date	:	03/10/2022

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