1124108527 NPI number — MS. JULIE MICHELLE WIECHENS M.S.W., L.C.S.W

Table of content: LILIBETH SALAZAR N.P. (NPI 1053738252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124108527 NPI number — MS. JULIE MICHELLE WIECHENS M.S.W., L.C.S.W

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WIECHENS
Provider First Name:
JULIE
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.W., L.C.S.W
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:
1124108527
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2440 EXECUTIVE DR
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
SAINT CHARLES
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63303-5607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-447-1902
Provider Business Mailing Address Fax Number:
636-447-1902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2440 EXECUTIVE DR
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
SAINT CHARLES
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63303-5607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-447-1902
Provider Business Practice Location Address Fax Number:
636-447-1902
Provider Enumeration Date:
10/17/2006

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: 1041C0700X , with the licence number:  2001022988 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 300138569 . This is a "PROVIDER IDENTIFICATION" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 194696 . This is a "PROVIDER IDENTIFICATION" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 494785314 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 539410 . This is a "PROVIDER IDENTIFICATION" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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