Provider Demographics
NPI:1922818475
Name:WHALEN-KONDZIELSKI, MIKAELA (APC, NCC)
Entity type:Individual
Prefix:
First Name:MIKAELA
Middle Name:
Last Name:WHALEN-KONDZIELSKI
Suffix:
Gender:F
Credentials:APC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21665 S TROLLEY DR
Mailing Address - Street 2:
Mailing Address - City:VENANGO
Mailing Address - State:PA
Mailing Address - Zip Code:16440-2229
Mailing Address - Country:US
Mailing Address - Phone:814-547-9872
Mailing Address - Fax:
Practice Address - Street 1:5100 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-2482
Practice Address - Country:US
Practice Address - Phone:814-866-4690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAPC000756101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health