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General NPI Number Information
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NPI Number | 1285583831
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Entity Type | Individual
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Provider Name | CORRIE MARIE WEISE
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Gender | Female
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Dates
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Enumeration Date | 01/27/2026
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 4140 RICHARD AVE STE 200&300
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City | HERMANTOWN
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State | MN
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Zip | 55811-2869
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Country | US
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Telephone | 218-673-3253
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Fax |
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Provider Business Mailing Address
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Address Line | 315 N 3RD AVE E APT 304
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City | DULUTH
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State | MN
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Zip | 55805-1853
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Country | US
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Telephone | 218-673-3253
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Fax |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | MN
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