Healthcare Provider Details

I. General information

NPI: 1831017169
Provider Name (Legal Business Name): CATHERINE WEIDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N 26TH ST
LAFAYETTE IN
47904-2895
US

IV. Provider business mailing address

1808 CHARLES ST
LAFAYETTE IN
47904-1430
US

V. Phone/Fax

Practice location:
  • Phone: 866-682-5539
  • Fax:
Mailing address:
  • Phone: 574-228-1072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: