1013524669 NPI number — MRS. WESLEY HOLMES KONESKY M. ED, ED. S

Table of content: MRS. WESLEY HOLMES KONESKY M. ED, ED. S (NPI 1013524669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013524669 NPI number — MRS. WESLEY HOLMES KONESKY M. ED, ED. S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KONESKY
Provider First Name:
WESLEY
Provider Middle Name:
HOLMES
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M. ED, ED. S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013524669
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1649 SAINT GEORGE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOWLING GREEN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43402-5234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-494-6656
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5600 MONROE ST STE 103B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYLVANIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43560-2795
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-885-5952
Provider Business Practice Location Address Fax Number:
419-885-7630
Provider Enumeration Date:
09/28/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TS0200X , with the licence number:  SP00660 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: SP00660 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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