Healthcare Provider Details

I. General information

NPI: 1699875070
Provider Name (Legal Business Name): ROBERT JAMES WENIGER PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 VILLA RD
NEWBERG OR
97132-1832
US

IV. Provider business mailing address

515 VILLA RD
NEWBERG OR
97132-1832
US

V. Phone/Fax

Practice location:
  • Phone: 503-819-7969
  • Fax:
Mailing address:
  • Phone: 503-819-7969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2035
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number2035
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2035
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: