Provider Demographics
NPI:1790560423
Name:WENGLEWSKI, KYRA JANE
Entity Type:Individual
Prefix:
First Name:KYRA
Middle Name:JANE
Last Name:WENGLEWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8715 31ST ST W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-2242
Mailing Address - Country:US
Mailing Address - Phone:918-284-8370
Mailing Address - Fax:
Practice Address - Street 1:8715 31ST ST W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-2242
Practice Address - Country:US
Practice Address - Phone:918-284-8370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor