1992072532 NPI number — MR. FREDERICK JOSEPH WESTON JR. MSW

Table of content: MR. FREDERICK JOSEPH WESTON JR. MSW (NPI 1992072532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992072532 NPI number — MR. FREDERICK JOSEPH WESTON JR. MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WESTON
Provider First Name:
FREDERICK
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MSW
Provider Gender Code:
M

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:
1992072532
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 S 6TH ST
Provider Second Line Business Mailing Address:
HCGC 14-A
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55487-0999
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-348-3072
Provider Business Mailing Address Fax Number:
612-677-6248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 S 6TH ST
Provider Second Line Business Practice Location Address:
HCGC 14-A
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55487-0999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-348-3072
Provider Business Practice Location Address Fax Number:
612-677-6248
Provider Enumeration Date:
11/28/2011

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: 104100000X , with the licence number:  NONE , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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