Individual provider Active NPI

Anna Elizabeth Wisniewski, CDCA

  • Addiction (Substance Use Disorder) Counselor
  • Parma, OH
National Provider Identifier
1922565373
Registry record updated Feb 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
CDCA.174445 Issued in OH
Practice address
6900 Ridge Rd Ste 200
Parma, OH 44129-5650
Phone
(440) 887-1100
Fax
(440) 887-1103
NPI assigned
Feb 21, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X CDCA.174445 OH Primary

Addresses

Primary practice location

6900 Ridge Rd Ste 200
Parma, OH 44129-5650

Mailing address

6900 Ridge Rd Ste 200
Parma, OH 44129-5650
Phone (440) 887-1100

Other practice location 1

14707 S Cheshire St
Burton, OH 44021-9601
Phone (440) 887-1100 ext. 243

Other identifiers 1

IdentifierTypeStateIssuer
0336209MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
CDCA.174445OHMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
McIntyre Center Inc. PastSince Nov 1, 2024 Accepting new patients
Kelli Anne Chamberlain Past Accepting new patients
McIntyre Center Inc. Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1550707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707264000000",
    "number": "1922565373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6900 RIDGE RD STE 200",
            "city": "PARMA",
            "state": "OH",
            "postal_code": "441295650",
            "telephone_number": "440-887-1100",
            "fax_number": "440-887-1103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6900 RIDGE RD STE 200",
            "city": "PARMA",
            "state": "OH",
            "postal_code": "441295650",
            "telephone_number": "440-887-1100",
            "fax_number": "440-887-1103"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14707 S Cheshire St",
            "address_purpose": "LOCATION",
            "city": "Burton",
            "state": "OH",
            "postal_code": "440219601",
            "country_code": "US",
            "telephone_number": "440-887-1100 x243",
            "fax_number": "440-887-1103",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WISNIEWSKI",
        "first_name": "ANNA",
        "middle_name": "ELIZABETH",
        "credential": "CDCA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-21",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "CDCA.174445",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0336209",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Parma, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.