Healthcare Provider Details

I. General information

NPI: 1871935239
Provider Name (Legal Business Name): ROXANE C WEDDLE MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 CAPITAL DR
W SPRINGFIELD MA
01089-1344
US

IV. Provider business mailing address

51 CAPITAL DR
W SPRINGFIELD MA
01089-1344
US

V. Phone/Fax

Practice location:
  • Phone: 413-737-2679
  • Fax: 413-306-6053
Mailing address:
  • Phone: 413-737-2679
  • Fax: 413-306-6053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: