Healthcare Provider Details

I. General information

NPI: 1639004021
Provider Name (Legal Business Name): MANDEE F WEAVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

942 CAROL ST
FORT MORGAN CO
80701-3520
US

IV. Provider business mailing address

440 N BARRANCA AVE # 9605
COVINA CA
91723-1722
US

V. Phone/Fax

Practice location:
  • Phone: 720-234-2321
  • Fax:
Mailing address:
  • Phone: 415-322-8857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: