Provider Demographics
NPI:1831592526
Name:KELLON, WENDY MARIE (MA)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:MARIE
Last Name:KELLON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16781 CHAGRIN BLVD
Mailing Address - Street 2:#117
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-3721
Mailing Address - Country:US
Mailing Address - Phone:216-577-1050
Mailing Address - Fax:216-274-9986
Practice Address - Street 1:29325 CHAGRIN BLVD
Practice Address - Street 2:SUITE 313
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4600
Practice Address - Country:US
Practice Address - Phone:216-360-4606
Practice Address - Fax:216-274-9986
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program