MEDICARE: DR. JOSHUA WEILER PSY.D, LP

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	LP5791	MN

General Provider Information

NPI Number	:	1235532615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA WEILER PSY.D, LP

Provider Business Mailing Address
First Line	:	2318 PARK AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-3712
Country	:	US
Telephone Number	:	612-871-7443
Fax Number	:

Provider Business Practice Location Address
First Line	:	2318 PARK AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-3712
Country	:	US
Telephone Number	:	612-871-7443
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2014
Last Update Date	:	09/30/2014

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