Provider Demographics
NPI:1083033823
Name:WECKERLY, KRISTA (MSW, LISW)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:WECKERLY
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:BRAWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LISW
Mailing Address - Street 1:275 MARTINEL DR
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-4380
Mailing Address - Country:US
Mailing Address - Phone:330-673-6446
Mailing Address - Fax:330-673-6443
Practice Address - Street 1:275 MARTINEL DR
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-4380
Practice Address - Country:US
Practice Address - Phone:330-673-6446
Practice Address - Fax:330-673-6443
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS12011921041C0700X
OHI15023511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical