MEDICARE: KELLY A WIECZOREK LPCC

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	101YP2500X	Professional Counselor
2	101YP2500X	Professional Counselor	E.2404015	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427677921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY A WIECZOREK LPCC

Provider Business Mailing Address
First Line	:	6500 ROCKSIDE RD STE 385
Second Line	:
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-2353
Country	:	US
Telephone Number	:	216-468-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	6500 ROCKSIDE RD STE 385
Second Line	:
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-2353
Country	:	US
Telephone Number	:	216-468-5000
Fax Number	:

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

Provider Enumeration Date	:	04/14/2020
Last Update Date	:	03/04/2025

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Directions to “ KELLY A WIECZOREK LPCC” Practice Location

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