MEDICARE: JANE F WEILENMAN, PHD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY002596	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235123910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANE F WEILENMAN, PHD, LLC

Provider Business Mailing Address
First Line	:	400 JOHNNY MERCER BLVD
Second Line	:	P O BOX 30633
City	:	SAVANNAH
State	:	GA
Zip	:	31410-2166
Country	:	US
Telephone Number	:	912-667-7716
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 JOHNNY MERCER BLVD
Second Line	:	SUITE G
City	:	SAVANNAH
State	:	GA
Zip	:	31410-2144
Country	:	US
Telephone Number	:	912-667-7716
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. JANE F WEILENMAN
Credential	:	PHD
Telephone Number	:	912-667-7716

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	06/18/2008

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