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General NPI Number Information
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NPI Number | 1053524082
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Entity Type | Individual
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Provider Name | ALICE R. WIEDENHOFF PHD
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Gender | Female
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | NORTH COUNTY CHILD STUDY CENTER, 6949 EL CAMINO REAL STE. 201
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City | CARLSBAD
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State | CA
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Zip | 92009-4140
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Country | US
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Telephone | 769-603-7770
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Fax | 760-603-7753
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Provider Business Mailing Address
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Address Line | NORTH COUNTY CHILD STUDY CENTER, 6949 EL CAMINO REAL STE. 201
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City | CARLSBAD
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State | CA
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Zip | 92009-4140
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Country | US
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Telephone | 769-603-7770
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Fax | 760-603-7753
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 17454
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number |
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License Number State |
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