Provider Demographics
NPI:1225280779
Name:WIEWIORA, SHELLY ANN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:ANN
Last Name:WIEWIORA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 PECK ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-2530
Mailing Address - Country:US
Mailing Address - Phone:231-722-7770
Mailing Address - Fax:231-722-7677
Practice Address - Street 1:1633 PECK ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-2530
Practice Address - Country:US
Practice Address - Phone:231-722-7770
Practice Address - Fax:231-722-7677
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009289101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional