Provider Demographics
NPI:1285990630
Name:WYZKOSKI, SHANNON LYNN (LPC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LYNN
Last Name:WYZKOSKI
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 1:4025 HAZELJACK DR
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-2323
Mailing Address - Country:US
Mailing Address - Phone:412-427-9034
Mailing Address - Fax:
Practice Address - Street 1:5250 CASTE DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-1502
Practice Address - Country:US
Practice Address - Phone:412-469-9771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005963101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health