Healthcare Provider Details

I. General information

NPI: 1679393078
Provider Name (Legal Business Name): KRISTIN WEEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 WOODLEY RD
TOLEDO OH
43606-1169
US

IV. Provider business mailing address

10 W GRAMERCY AVE
TOLEDO OH
43612-2539
US

V. Phone/Fax

Practice location:
  • Phone: 567-225-3969
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: