Healthcare Provider Details

I. General information

NPI: 1780815043
Provider Name (Legal Business Name): JACQUELINE BABBS WIEBE PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACQUELINE BABBS FINKBONER PH.D

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 MARSH LN
PLANO TX
75093-8497
US

IV. Provider business mailing address

2301 MARSH LN
PLANO TX
75093-8497
US

V. Phone/Fax

Practice location:
  • Phone: 972-428-1652
  • Fax: 972-428-1606
Mailing address:
  • Phone: 972-428-1652
  • Fax: 972-428-1652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number24726
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: