Healthcare Provider Details

I. General information

NPI: 1902979743
Provider Name (Legal Business Name): JESSE DILLON WEIDNER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSE DILLON PSYD

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 W CEDAR ST STE 120
PENSACOLA FL
32502-5945
US

IV. Provider business mailing address

3485 SHANNON PL
PENSACOLA FL
32504-4480
US

V. Phone/Fax

Practice location:
  • Phone: 850-462-8925
  • Fax:
Mailing address:
  • Phone: 850-529-3606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number016706
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY7678
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: