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General NPI Number Information
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NPI Number | 1477604056
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Entity Type | Individual
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Provider Name | JOANNE I WIESER MA
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Gender | Female
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 11/22/2011
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Provider Practice Location Address
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Address Line | 411 N. 3RD ST. SUITE A3
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City | ELMA
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State | WA
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Zip | 98541
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Country | US
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Telephone | 360-861-8184
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Fax | 360-482-3527
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Provider Business Mailing Address
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Address Line | PO BOX 133 411 N. 3RD. ST. SUITE A3
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City | ELMA
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State | WA
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Zip | 98541
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Country | US
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Telephone | 360-861-8184
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Fax | 360-482-3527
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CP00000130
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | RC00021305
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LF00002627
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License Number State | WA
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