Khannah Keziah Wetmore, LISW-S

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I.2204081-SUPV Issued in OH

Practice address

23625 Commerce Park Ste 100
Beachwood, OH 44122-5847

Phone

(216) 468-5000

Fax

(216) 831-4410

NPI assigned

Jun 27, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Psychological and Behavioral Consultants LLCGroup PAC ID 0446243760, 595 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Psychological & Behavioral Consultants, LLC

  • Psychiatry Physician
  • Beachwood, OH
  • NPI 1811915713

  Clinical

  Medicare reassignment Care Compare group NPD
• Hospice of the Western Reserve, Inc.

  • Pediatric Hospice and Palliative Medicine Physician
  • Cleveland, OH
  • NPI 1255333753
  NPD (past)
• Hospice of the Western Reserve, Inc.

  • Clinical Nurse Specialist
  • Cleveland, OH
  • NPI 1811163009
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776902400000",
    "number": "1629754122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "341 E 235TH ST",
            "city": "EUCLID",
            "state": "OH",
            "postal_code": "441231509",
            "telephone_number": "620-253-4179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23625 COMMERCE PARK STE 100",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441225847",
            "telephone_number": "216-468-5000",
            "fax_number": "216-831-4410"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 E 185th St",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "441191330",
            "country_code": "US",
            "telephone_number": "216-383-2222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WETMORE",
        "first_name": "KHANNAH",
        "middle_name": "KEZIAH",
        "credential": "LISW-S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-27",
        "last_updated": "2026-04-23",
        "certification_date": "2026-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.2204081-SUPV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maureen Lorraine West, MSW
• Western Reserve Dermatology, Inc
• Western Reserve Ophthalmology Inc
• Western Reserve Periodontics, Inc
• Western Reserve Vision Care, Inc.
• Diane L Wetzig, PHD
• Dymon Whatley, QMHS
• Jessica Diondra Liane Wheeler
• Benjamin A White, PT, DPT
• Chantaisia White

• Clinical Social Worker in Beachwood, OH
• Providers in Beachwood, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.